Initial evaluation and therapeutic strategy for arterial hypertension

Depending on the etiology and concomitant diseases, initial evaluation and treatment of arterial hypertension can range from a simple clinical and laboratory examination with a prescription for lifestyle modification, to an extensive multisystem work-up that results in removal of a hormone-producing tumor. Various features of the history, physical examination and initial laboratory tests determine where the patient fits in this spectrum of disease. The decision to order a specialized test should be individualized and directed by the initial assessment; ordering "everything" to be "thorough," from plasma metanephrines to a magnetic resonance angiogram of the renal arteries, is bad medicine. Similarly, a blood pressure-lowering regimen should be individualized to focus attention on those aspects of the patient's lifestyle that can be altered, and on the concomitant diseases and risk profile that dictates blood pressure goals and initial choice of medication.