Diagnosis of Hypertension (High Blood Pressure)

The diagnosis of hypertension is a crucial step in preventing cardiovascular diseases and related complications. Physicians typically conduct a systematic assessment of the patient's medical history, physiological data, and auxiliary examinations to confirm whether blood pressure remains persistently elevated. The diagnostic process not only aims to exclude secondary hypertension caused by other diseases but also evaluates the patient's cardiovascular risk level to formulate personalized treatment plans.

The accuracy of blood pressure measurement is vital for diagnosis. Physicians avoid measuring blood pressure immediately after the patient is tense or active and may use multiple measurement methods for cross-verification. Additionally, they consider factors such as the patient's age, family history, and lifestyle habits to determine whether further blood tests, urine analysis, or imaging examinations are necessary.

Clinical Evaluation

The first step in diagnosing hypertension is a detailed clinical assessment. Physicians inquire about subjective symptoms; although hypertension is often called the “silent killer,” some patients may experience nonspecific symptoms such as headaches, dizziness, or chest tightness. Furthermore, they will review medication history, including long-term use of steroids or analgesics, which may induce blood pressure elevation.

Analysis of family history is a key evaluation component. If first-degree relatives (parents, siblings) have early-onset cardiovascular disease or hypertension, the patient's risk significantly increases. Physicians also assess other comorbidities such as diabetes, kidney disease, or metabolic syndrome, which may be associated with hypertension.

Medical Examinations and Procedures

Standard blood pressure measurement must follow strict protocols: the patient should sit quietly for 5-10 minutes, use an appropriately sized cuff on the right arm, and record blood pressure in both sitting and standing positions. If initial screening results are abnormal, physicians usually arrange 24-hour ambulatory blood pressure monitoring (ABPM) to exclude the interference of “white coat hypertension” (white coat effect). This monitoring captures blood pressure fluctuations during daily activities, providing a more accurate assessment of true blood pressure levels.

Blood and urine tests are common auxiliary examinations. Blood tests include lipid profile (total cholesterol, low-density lipoprotein), blood glucose levels, renal function indicators (creatinine, blood urea nitrogen), and electrolyte balance. Urinalysis focuses on proteinuria and red blood cell examination to assess kidney damage, which is crucial for differentiating primary from secondary hypertension.

Screening and Assessment Tools

Home blood pressure monitoring is an important screening tool. Patients can use validated electronic blood pressure monitors to measure and record data daily at home. This long-term tracking effectively supplements single measurements in medical settings, especially for patients suspected of having “masked hypertension.” Physicians may require measurements over 7 consecutive days and calculate the average to exclude occasional fluctuations.

Risk assessment tools such as the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator integrate data like age, gender, and lipid levels to estimate the 10-year risk of heart attack or stroke. These tools assist physicians in determining whether aggressive treatment is necessary and in setting individualized blood pressure targets.

Differential Diagnosis

The primary goal is to exclude secondary hypertension, which accounts for about 5-10% of all cases. Common causes include renal artery stenosis, glomerulonephritis, endocrine disorders (such as pheochromocytoma, Cushing's syndrome), and medication-induced hypertension (such as oral contraceptives, NSAIDs). Physicians may order renal ultrasound, thyroid function tests, or adrenal CT scans for confirmation.

Special examinations like arterial stiffness measurement and pulse wave velocity analysis can help assess vascular stiffness and determine the long-term impact of hypertension on the heart. In some cases, physicians may perform renin-aldosterone system testing to confirm whether endocrine metabolic abnormalities are the primary cause.

The Importance of Early Diagnosis

Early diagnosis can effectively reduce the risk of severe complications such as cardiac hypertrophy, stroke, and renal failure. For patients under 30 or with rapidly rising blood pressure, physicians will particularly investigate secondary causes, as the likelihood of primary hypertension is relatively low in these cases. Regular health check-ups are key to early detection; it is recommended that adults over 30 measure their blood pressure at least once a year.

For diagnosed patients, early treatment can delay vascular damage progression. Studies show that lowering blood pressure by 10 mmHg reduces the risk of heart attack by 15% and stroke by 25%. This underscores the clinical value of early diagnosis and continuous monitoring.

 

Frequently Asked Questions

Why is home blood pressure measurement crucial for diagnosing hypertension?

Home blood pressure measurement helps exclude the “white coat hypertension” phenomenon, where patients experience temporary blood pressure elevation due to anxiety in medical settings. Regular measurements at home record typical blood pressure trends, providing more comprehensive data to assist physicians in determining whether treatment is necessary. It is recommended to use validated electronic blood pressure monitors, measure at the same time daily, and record the data for physician reference.

What are the differences between ambulatory blood pressure monitoring and clinic measurements?

Ambulatory blood pressure monitoring involves wearing a sensor for 24 hours, capturing blood pressure changes during daily activities, including whether nighttime blood pressure drops normally (non-dipping phenomenon). This method can detect masked hypertension or insufficient medication effects, especially useful in cases where diagnosis is suspected but temporary measurements are abnormal. It offers higher accuracy than single clinic measurements.

Do hypertensive patients need regular cardiovascular examinations?

Yes. After diagnosing hypertension, physicians may order blood biochemical tests (such as blood glucose, lipids), echocardiography, or urine protein tests to evaluate vascular damage and complication risks. For older patients or those with signs of target organ damage, arteriosclerosis-related examinations like carotid ultrasound may also be recommended.

How can dietary adjustments assist in diagnosing and controlling hypertension?

Adopting a low-sodium, high-potassium diet (such as the DASH diet) can reduce blood pressure by about 5-10 mmHg. Reducing processed foods and increasing intake of potassium, calcium, magnesium-rich foods (such as bananas, spinach, low-fat dairy) can improve diagnostic accuracy and decrease the need for medication. It is advised to keep daily sodium intake below 2,300 mg and consult a nutritionist for personalized dietary planning.

What health checks should hypertensive patients undergo before starting exercise?

If blood pressure is in the second stage (≥140/90 mmHg) or there is a history of heart disease, a cardiopulmonary exercise test should be performed before starting physical activity. Doctors may also recommend tests for venous thrombosis risk or retinal vascular status to prevent complications from high-intensity exercise. Starting with moderate to low-intensity exercise and gradually increasing while monitoring blood pressure responses is recommended.