Mandatory medical device diagnostics.
- Repeated blood pressure measurement on both arms with cuff adjusted to arm circumference. Measurement conditions: Blood pressure measurement after a five-minute relaxation period and at rest. Three blood pressure measurements are then taken at intervals of one to two minutes. From these, the mean value is calculated. [Only after at least 3 times measurement at different times, the diagnosis of hypertension can be made].
- 24-hour blood pressure measurement: usually as ambulatory blood pressure monitoring (ABDM; engl. ambulatory blood pressure monitoring, ABPM) to confirm the diagnosis of hypertension and to prevent white coat hypertension (white coat hypertension). [if blood pressure is too high at night, then the risk of myocardial infarction (heart attack) and apoplexy (stroke) is highest:
- Systolic increase of 10 mmHg results in a 25% increased risk of cardiovascular events (1).
- Diastolic pressure:
- 110 mmHg measured in the office increased the rate of cardiovascular events by 20% during the follow-up period
- 110 mmHg measured at night, 60% of these patients later suffered myocardial infarction or apoplexy (2)]
- Electrocardiogram (12-lead ECG; recording of the electrical activity of the heart muscle) – to rule out arrhythmias, signs of myocardial ischemia (impaired blood flow to the heart muscle) [left ventricular hypertrophy (LVH): Sokolow-Lyon ≥ 35 mm, Cornell QRS > 2.8 mV].
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnosis.
- Echocardiography (echo; cardiac ultrasound) – for suspected heart disease such as heart failure (cardiac insufficiency).
- Transthoracic echocardiography (echo; cardiac ultrasound) – indicated in pathological basic diagnostics to determine the left ventricular wall thickness (wall thickness of the left ventricle); exclusion of aortic valve insufficiency (defective closure of the aortic valve of the heart).
- Electrocardiogram (12-lead ECG).
- Exercise ECG using ergometry (measurement of cardiovascular performance parameters during targeted physical exertion) – to rule out coronary artery disease (CAD).
- Long-term ECG examination – in case of suspected arrhythmia.
- Intima-media thickness measurement – to detect subclinical atherosclerosis (arteriosclerosis, hardening of the arteries).
- Arterial elasticity (ASI) measurement – noninvasive measurement of arterial elasticity; measures the extent of atherosclerosis (atherosclerosis, hardening of the arteries); main feature of elevated isolated systolic blood pressure is arterial stiffness
- Ankle-brachial index (ABI; examination method that can describe the risk of cardiovascular disease – the test is considered highly specific and sensitive to detect peripheral arterial disease (pAVD)
- Duplex sonography of extracranial cerebral vessels – to detect vascular changes (e.g., risk stratification apoplexy/stroke).
- Binocular biomicroscopic funduscopy with a dilated pupil – used when diastolic blood pressure exceeds 110 mmHg (to detect malignant hypertension)
- Duplex sonography of the pelvic-leg vessels – used to rule out vascular occlusion (e.g., thrombosis) or stenosis (constriction)).
- X-ray of the thorax (chest x-ray/chest x-ray), in two planes – to determine heart size/configuration; exclusion of aortic aneurysm (aortic bulge)
- Abdominal ultrasonography (ultrasound examination of abdominal organs) – for suspected renal changes (renal hypertension) with duplex sonography of renal arteries to exclude renal artery stenosis;
- Angiography (imaging of blood vessels by contrast medium in an X-ray examination) – for imaging of the renal vessels if a renal (kidney-related) cause of hypertension is suspected.
- Computed tomography (CT) angiography – to visualize the renal vessels when a renal (kidney-related) cause of hypertension is suspected.
- Renal scintigraphy – to visualize renal function when a renal cause of hypertension is suspected.
- Myocardial scintigraphy or cardiac catheterization – for suspected coronary artery disease (CAD) or Acute coronary syndrome (ACS; Acute coronary syndrome); the latter describes a spectrum of cardiovascular diseases ranging from unstable angina pectoris (“chest tightness”; sudden pain in the heart area with inconstant symptoms) to the two main forms of myocardial infarction (heart attack), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).
- Sleep apnea screening – if sleep apnea (breathing pauses during sleep) is suspected.
Masked hypertension (= normal blood pressure in the office, but in the everyday life of the patient are actually elevated values).
- In the Masked Hypertension Study, it was shown that blood pressure is underestimated rather than overestimated in practice measurements (= masked hypertension). The practice values of healthy participants were on average 7/2 mmHg lower than their values in the 24-hour ambulatory blood pressure measurement (ABPM). This particularly affected younger, lean individuals. In more than one-third of the study participants, the systolic ambulatory value exceeded the practice value by more than 10 mmHg. A 10 mmHg higher practice blood pressure than the ABPM value occurred in only 2.5% of participants.Conclusion: white coat hypertension thus receives a different status than in the past.The prevalence of white coat hypertension in Germany is about 13%.
- With high-normal blood pressure values in the practice must be searched for other risk factors:
