High Blood Pressure - Initial Investigations

You may wonder why your high blood pressure was not diagnosed until you had to have a medical for your new insurance policy. This is probably because you had not had your blood pressure measured for some years. Like you, many people with high blood pressure have no symptoms at all. The only way to know if you have high blood pressure is to have it measured on a regular basis. If the only medical check-ups you have are for insurance or perhaps before you start a new job, then those are the only times when anyone has the chance to measure your blood pressure and find out that it is high.

Your physician may suggest that you take some tests. This is mainly for two essential reasons. The first is to assess how much organ damage has already been done and to establish baseline values so that any possible damage can be assessed in the future. Unless your normal pattern is recorded from the beginning, apparent changes later on may be misinterpreted. The main target organs of high blood pressure are the large and small arteries everywhere in the body, but especially in the brain, eyes, heart and kidneys. Measurable damage of this sort is not very common under 40 years of age, except in people with diastolic pressures sustained above 120 mmHg for many years. The other reason is to find out if your high blood pressure is the less common secondary type. The "classical" causes of secondary high blood pressure are all rare, accounting for less than 1% of all cases of high blood pressure. In practice, they are usually searched for in two stages: before treatment begins and then later on if treatment unaccountably fails. For example, if after several months of treatment, your blood pressure was still not under control or if after several years of good control, your blood pressure became uncontrollable despite continued treatment, then a secondary cause might be sought, starting with investigations to see whether one of your kidney arteries had been blocked by a clot. Some very rare causes, such as the adrenal gland tumor phaeochromocytoma, are extremely difficult to find and require much persistence.

Before staring treatment, you should have your kidneys checked, which involves having simple urine tests for protein, bacteria and glucose and by having your blood urea and creatinine levels measured. All these tests require as far as you are concerned is providing a urine sample and having a small amount of blood taken from your arm. The results of these tests will provide a baseline measure for assessment of future organ damage and act as a check for possible causes. They may indicate a cause in the kidneys, which account for more than half of all cases of secondary high blood pressure.

When checking for pulses, in this case, uses those in your groin and your feet and ankles, instead of the pulse in your wrist. A quick check on the groin pulses in enough to exclude a very rare condition called coarctation of the aorta. The pulses in your feet and ankles provide information about the state of your leg and coronary arteries (arteries the supply blood to your heart). If you are over 40, then the health of your les and coronary arteries should be assessed by taking these pulses and by asking you if you regularly get pain in your calves or in the front of your chest after exercise such as prolonged walking or stair climbing and theses pains are worst cold whether. If you answer "yes" to your physician's question, this would suggest that you may have some artery problems.

Damage to the eyes usually only occurs in people with very high pressures and so most people will not need to have their eyes examined. However, people with very high pressures do need careful examination of the retina (the black part of the eye). The purpose of this exam is to look for bleeding and swelling around small retinal arteries, which reveal imminent high risk of serious damage to the eyes, brain and kidneys. When found, this is a medical emergency requiring urgent admission to the hospital.

Michael Russell
Your Independent guide to Blood Pressure

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