Tests and Diagnosis

Hypertensive disease is difficult to diagnose because arterial hypertension can be asymptomatic for a long time. Patients with hypertension may have an active life for many years only occasionally complaining of dizziness and weakness.

The main diagnostic methods helping diagnose arterial hypertension are:

• Measurement of blood pressure in both arms should be performed using blood pressure monitor. Regular measurement of blood pressure for several days at different times of the day is used to detect hypertension and understand its severity – it is called blood pressure profile. You should not drink coffee, alcohol, or smoke before the measurement. It’s recommended to sit calmly leaning back in the chair for several minutes.
• Clinical examination consisting of the patient’s complaints and assessment of the risk factors (diabetes, smoking, atherosclerosis, obesity, etc.). Also it is important to pay attention to the patient’s family history. Doctor performs auscultation, i.e. listening to the sounds of the heart using phonendoscope. Noises that indicate defects or changes in the heart can be detected during this procedure. The results obtained can indirectly confirm arterial hypertension.
• Electrocardiogram - a method helping record changes in the electrical potentials of the heart in time. It’s an indispensable diagnostic method, first of all, of various cardiac rhythm disturbances. Besides, ECG is used to detect the so-called hypertrophy of the left ventricular wall, which is characteristic of hypertension.
• The measurement of blood pressure can be most accurately performed with the help of a daily blood pressure monitoring usually combined with simultaneous recording of ECG. This method involves putting an automatic monitor on the patient’s arm, this device records blood pressure for 24 hours with programmed intervals, these intervals vary from 30-60 minutes during the daytime and up to 60-120 minutes at night. As a result, a 24-hour monitoring provides several tens of results. Basing on the data obtained doctors can evaluate the average arterial pressure during the whole day, at night and in the daytime. In addition to the numbers of blood pressure, you can get data that indirectly speaks for the diagnosis of arterial hypertension. For example, doctor can decide on the presence or absence of hypertensive disease basing on the speed and value of the decrease in arterial pressure at night or the speed with which it increases in the morning.

Besides the described diagnostic methods, there are other tests:

• Echocardiography of the heart. It helps detect heart defects, changes in the heart walls thickness and evaluate the condition of the heart valves.
• Arteriography (including aortography). It’s an X-ray diagnostic method used to examine the walls of the arteries and their lumens. This procedure helps detect atherosclerotic plaques in the walls of the coronary arteries, congenital narrowing of the aorta, etc.
• Doppler ultrasound. It’s an ultrasound method used to evaluate the condition of the bloodstream in the blood vessels (both in the arteries and veins). In the case of hypertension, the first thing the doctor is interested in is the condition of the carotid and cerebral arteries.
• Biochemical blood analysis. This method is also used for the diagnosis of hypertension. First of all, the levels of the following parameters should be evaluated:
  • cholesterol;
  • high, low and very low density lipoproteins;
  • blood sugar.
• The tests to evaluate kidney functioning are also used to diagnose arterial hypertension:
  • simple urine test;
  • biochemical blood test (the levels of creatinine and urea);
  • ultrasound of the kidneys and their vessels.
• Ultrasound of the thyroid gland and blood test for thyroid hormones. These diagnostic methods help understand the role played by the thyroid gland in the progression of arterial hypertension.

Next chapter: Treatment and Prevention of Hypertension