Medical examination of hypertension

A doctor-patient conversation takes place at the start of the medical examination of hypertension. For diagnosing hypertension and the subsequent assessment of the results of the examination, your medical history (anamnesis) is a key indicator for your internal specialist. He will therefore ask the following:

  1. Is there a genetic predisposition to increased blood pressure and/or heart disease? (i.e. have close relatives suffered from hypertension, a heart attack, a stroke, gout) or high cholesterol levels (hypercholesterolemia)?)
  2. Do you have a history of complaints, e.g. heart problems, diabetes, renal disease or metabolic disease?
  3. Are there other risk factors (e.g. obesity, smoking, alcohol)?
  4. Do you have a lot of stress? Are you under pressure mentally or in your job (e.g. shift work)?
  5. What medication do you take on a regular basis?

Physical examination
The physical examination concentrates primarily on the measurement of blood pressure. This should be carried out several times in a relaxed atmosphere. A one-off reading, indicating elevated blood pressure is not reliable. This is because nervousness, for instance, can temporarily increase blood pressure. Some patients are so nervous when they visit the doctor's surgery that it is only there that they exhibit excessive blood pressure ('doctor's surgery hypertension' and 'white coat hypertension'). But even under normal conditions blood pressure is subject to significant fluctuations and reflects physical and mental stress. Reliable results are only obtained through repeated measurements and/or blood pressure measurements over a 24-hour period (e.g. if ‘doctor’s surgery hypertension' or sleep apnoea (short respiratory arrest during sleep) is suspected.

The blood pressure measurements are made on different days on both upper arms whilst sitting (later, only on the arm with the higher values, usually the right) after a period of rest lasting 3 to 5 minutes. As a guideline: If the blood pressure raised during repeated measurements on different days (over 140/90 mmHg), then there is hypertension. However, when assessing the blood pressure values, potential secondary disorders should always be taken into account.

As a basic principle, your internal specialist will also weigh you, as well as listen to your lung and heart with a stethoscope. Initial blood and urine tests are also part of the basic diagnostics and in the first place provide indications of possible additional risk factors and 'end organ' damage. The condition of the kidneys (renal size and the composition of the renal tissue) are reviewed by means of an ultrasound examination of the kidneys (kidney sonography). If the kidneys are very small, this may be an indication of a renal impairment that has already existed for a longer period of time.

A possible thickening of the heart muscle or heart rhythm disturbances can be recognised on the basis of an electrocardiogram (ECG).

If necessary - among other things, depending on the blood pressure level, age, secondary disorders - the following examinations are also used:

  • Long term blood pressure measurement
  • Exercise electrocardiograms
  • Ultrasound examination of the heart (echocardiography)
  • Ultrasound examination of the leg and neck vessels
  • Examination of the ocular fundus by the eye specialist
  • Special laboratory examinations
     

If an underlying disease causes the high pressure (secondary hypertension), your internal specialist will usually diagnose this within the context of the examinations described above. Blood pressure values that have suddenly increased and non-response to drug therapy may also indicate secondary hypertension.

What is hypertension?