Evaluation of the Hypertensive Patient with Emphasis on Detecting Curable Causes

Abstract

Being only palliative, the medical treatment of hypertension must be continued throughout the lifetime of the patient. To avoid unnecessary or ill-conceived treatment, to judge prognosis and to establish a baseline from which the efficacy of treatment can be judged, each hypertensive patient deserves a thorough evaluation before therapy is instituted, unless the urgency of the situation demands immediate treatment. In that case, evaluation can and should be postponed until the life-threatening hypertension has been controlled. The objectives of the evaluation of the hypertensive patient are fourfold: (1) to evaluate the patient's general health. It may be inadvisable to treat hypertension when the patient has a disease that is a greater threat to his survival than the elevated blood pressure. Coexisting disease, such as diabetes, gout or hepatic dysfunction, may also influence the choice of drugs used to treat hypertension. (2) To discover curable causes of hypertension, such as pheochromocytoma, Cushing's syndrome, renal vascular disease, primary aldosteronism and coarctation of the aorta. Whereas patients with these conditions probably constitute less than ten per cent of the hypertensive population, many can be cured by appropriate operations and thereby be spared a lifetime of medical treatment that is frequently unpleasant, sometimes ineffective (especially in regard to pheochromocytoma) and always expensive. (3) To evaluate the effect, if any, of the hypertension on target organseye, brain, heart and kidneys. The presence or absence of complications has an important bearing on prognosis and should influence the choice of drugs employed. (4) To be certain that the patient has persistent