Increased BUN, creatinine, glucose, cholesterol, and triglyceride levels
Proteinuria, albuminuria, microscopic hematuria
Evidence of ischemic heart disease and left ventricular hypertrophy on ECG
Evidence of structural heart disease and left ventricular hypertrophy on echocardiogram; evidence of arteriovenous nicking, retinal hemorrhages, and papilledema on funduscopic examination
BP Measurement
Take in both arms initially
Proper size and placement of cuff
Can use forearm if needed
Document site
Assess for orthostatic hypotension
BP and HR supine, sitting, and standing
Measure within 1 to 2 minutes of position change
Positive if decrease of 20 mm Hg or more in SBP, decrease 10 mm Hg or more in DBP, or increased 20 beats/minute or more in heart rate
Teach patients about lifestyle management and drug use.
Evaluate the effectiveness of lifestyle management and drugs in decreasing BP to acceptable levels.
Teach about home BP monitoring, including the correct use of automatic BP monitors. Check that the device selected by the patient meets the Association for the Advancement of Medical
Instrumentation standards.
Make appropriate referrals to other HCPs, such as dietitians or stress management programs.
Monitor for complications of hypertension such as coronary artery disease, heart failure, cerebrovascular disease, peripheral vascular disease, and renal disease.
Assess the patient with hypertensive crisis for evidence of target organ disease (e.g., encephalopathy, renal insufficiency, cardiac decompensation).
Manage the patient with hypertensive urgency or emergency, including administration of drugs and evaluation for resolution of the crisis.
