Conditions
Hypertension
Diagnosis confirmation, baseline workup, and first-line management steps.
Last reviewed 2026-01-05|cardio | chronic | bp
Diagnosis
- Confirm elevated blood pressure with standardized office technique and out-of-office readings (home or ambulatory).
- Assess cardiovascular risk factors and review potential secondary causes.
Initial workup
- Baseline labs: electrolytes, creatinine/eGFR, fasting lipids, A1C, and urinalysis.
- ECG if long-standing hypertension or symptoms suggest target-organ effects.
- Document ASCVD risk and baseline complications (LVH, CKD, retinopathy).
First-line management
- Lifestyle: sodium reduction, DASH-style eating, weight management, exercise, limit alcohol.
- Start a first-line agent (thiazide-like diuretic, ACE inhibitor/ARB, or long-acting CCB) tailored to comorbidities.
- Titrate every 4-6 weeks and re-check renal function and potassium after changes.
Red flags
- Symptoms of hypertensive emergency (chest pain, neurologic deficit, acute dyspnea, vision changes).
- Rapid-onset or severe hypertension in pregnancy.
Referral triggers
- Resistant hypertension despite 3 agents including a diuretic.
- Suspected secondary hypertension, advanced CKD, or complex comorbidities.