The diagnosis of suspected hypertension should be confirmed by ambulatory blood pressure measurements or (better) by 24-hour blood pressure measurement. In young patients, in case of a negative family history, grade 2 or 3 hypertension, or treatment-resistant hypertension, the possibility of a secondary cause of hypertension should be considered. Before starting treatment, the patient’s age, cardiovascular risk factors, possible end-organ damage, and comorbidities should be taken into account. The choice of antihypertensive treatment is based on consideration of comorbidities and primarily includes renin-angiotensin system inhibitors, calcium channel blockers, beta-blockers, and diuretics. Treatment targets depend on age, health status, and comorbidities (diabetes).
The latest recommendations of the European Society of Hypertension and Cardiology were published in 2013 and serve as the basis for this article, along with other guidelines (UK 2011) [1,2]. Emphasis is placed on current therapy and therapeutic goals.
The values that define high blood pressure vary depending on the technique and location of measurement (summarized in Table 1 ).
In any patient with elevated blood pressure, the first step is to confirm the suspected diagnosis of hypertension. Whenever possible, blood pressure measurement should be performed outside the office by the patient or by long-term blood pressure measurement (24-hour blood pressure measurement). This test allows for the assessment of daytime blood pressure changes and nighttime dipping. It can also reveal a possible white-coat component of hypertension or masked hypertension.
Other steps before starting treatment
To determine the treatment strategy and choice of medications, the following questions should be answered after the diagnosis of hypertension:
What is the cause of hypertension? Could it be a secondary cause of hypertension? However, in case of clinical suspicion or abnormal laboratory results, a targeted evaluation for secondary causes of hypertension should be carried out (Table 2). A secondary cause of hypertension should be considered especially in patients with a negative family history, patients younger than 30 years, grade 2 or 3 hypertensive patients, or treatment-resistant arterial hypertensive patients [3].
What is the patient’s age, what is the cardiovascular risk, is there any end-organ damage? Age, cardiovascular risk factors, as well as comorbidities and possible end-organ damage are important for risk stratification and treatment planning. In all patients, baseline investigations should include complete blood count, creatinine, urea, electrolytes, uric acid, fasting glucose, HbA1c, lipid profile, spoturine with sediment to check for proteinuria or hyperproteinuria. Microalbuminuria and a 12-lead ECG should be performed. Then, the risk calculation and treatment strategy can be seen in Table 3 .
What are the known associated diseases? They influence the treatment strategy, target blood pressure values, and the choice of medications and should be assessed accordingly.