As well as giving an indication of your risk from particular diseases, regular checking of blood pressure can provide an easy and revealing way of monitoring the general condition of your body.
Who should be tested?
Everyone over the age of 50 should monitor their blood pressure on a regular basis, at least once a year.
As hypertension is so often undiscovered until it is too late, GP's and hospital workers will usually check it routinely. This is particularly important in high-risk people such as those with kidney problems, pregnant women, and individuals on medication. It is important for GP's to check blood pressure before prescribing new medication, as some drugs may exacerbate the problem.
Measuring blood pressure
Measuring blood pressure is a simple, routine test performed by GP's, hospital doctors, nurses and other healthcare professionals. Home testing kits and portable machines can also be used.
The test involves the use of what is called a 'sphygmomanometer', a cuff fitted around the upper arm and inflated to a pressure high enough to temporarily stop blood flow.
The pressure is then slowly lowered until the blood begins to flow again and the pulse can be detected. This is the systolic pressure. The pressure is then lowered further until the pulse is no longer evident. This is the diastolic pressure.
Detection of the pulse can be made with a stethoscope, or read directly from an automated blood-pressure monitor.
Identifying the type of hypertension
True vs false hypertension
One reading that is slightly elevated does not automatically mean the person has high blood pressure. Patients may give high readings on occasions and not others. In these situations it is important to determine whether the patient really is suffering from hypertension, especially if drugs are to be administered.
Ambulatory monitoring
Ambulatory monitoring, where a monitor is worn continually for 24 hours, is an effective way to determine whether a person has true hypertension or if the elevation is transient. By wearing the device during their normal daily routine, fluctuations in blood pressure can be monitored, for example after exercise, during work hours, and while relaxed.
This method of diagnosis is particularly useful in cases of 'white-coat' hypertension.
'White Coat' hypertension
This is where a patient whose blood pressure is normal gives elevated readings in the doctor's surgery due to anxiety brought on by the testing experience.
Systolic vs diastolic hypertension
Until recently it was thought that elevated diastolic pressure (the lower number) was more serious a health worry than elevated systolic pressure. It is now understood that isolated systolic hypertension (elevated systolic pressure in conjunction with normal diastolic pressure), especially in the older population, should be treated. |
Essential / primary vs secondary hypertension
Once it has been established that the patient is suffering from hypertension, it is important to establish the cause.
If the patient is already suffering from another illness, it is possible that the hypertension is secondary to that illness. One should not assume this is the case, however, and so routine checks such as assessing heart and lung function may be performed.
Where another illness is not the root of the problem, and hypertension is the primary illness, it is usually assumed that the cause is narrowing of blood vessels due to a build-up of fatty deposits. Medical history and lifestyle indicators will be assessed in order to confirm the suspected cause.
What happens next?
Once hypertension has been diagnosed the following factors will normally be assessed:
| Routine examinations for people with high blood pressure - Strength and regularity of pulse
- Checking peripheral circulation by monitoring pulse in groin, feet and ankles
- Checking heart beat in chest as indication of whether heart is enlarged or not
- Listening for heart murmurs and irregular rhythm
- Listening to lungs to check for fluid build-up and ankles for oedema
- Examining eyes for signs of arterial damage
- Since high blood pressure is one of a number of causes for major illnesses, screening is particularly useful for early detection in people with the condition
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| Routine screening for people with high blood pressure - Chest x-ray to check size and shape of heart, the backing-up of fluid in lungs, and for signs of congestive heart failure
- Electrocardiogram (ECG) to assess regularity of heartbeat, strength of heart muscle, and signs of left ventricular thickening
- Urinalysis will show sugar indicator diabetes and kidney problems
- Fasting blood lipid levels will check cholesterol and other blood fats levels, which are causative factors in heart disease
- Urea and electrolytes in the blood will reflect kidney function and salt balance, and could indicate the cause of the high blood pressure
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If blood pressure is suspected to be high due to another illness, testing wil be carried out to ascertain the cause.
| Screening for suspected hypertension - Blood tests to check hormone balance
- Blood tests to assess kidney function
- Intravenous Urogram - enables blood stream to be viewed via x-ray, to assess state of renal arteries
- Ultrasound of kidneys
- If body measurements indicate growth hormone imbalance, blood tests may be performed to assess levels
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Tests for unrelated illness
Hypertension is likely to affect the results of tests for other illnesses due to its alteration of the performance of certain organs and tissues. Tests affected include visual tests, red-blood-cell count, and liver-function tests.
02/06/2009