Depending on the findings, you could be referred to a specialist. If heart failure or enlargement of the heart chambers is suspected, an echocardiogram could be required. This test shows the size and pumping action of the heart. It can confirm early enlargement (hypertrophy) or thickening of the walls of the heart, due to hypertension. It is called “left ventricular hypertrophy” and requires more aggressive treatment.

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Referral to a specialist
Most hypertensive patients are treated by family doctors who will refer you for specialist treatment if indicated. Specialist treatment may be indicated in the following cases:

• Your blood tests or ECG is abnormal.
• You have multiple risk factors or complications of hypertension. 
• The specialist can help confirm possible “isolated systolic hypertension” and other less common conditions.
• If urgent treatment is needed, as in severe hypertension or malignant hypertension, referral is indicated. This includes certain conditions in pregnancy, called preeclampsia and eclampsia. 
• A specialist can help identify a possible underlying cause and assess the patient who is resistant to treatment. 
• Specialists usually manage problems with anti-hypertensive drugs like intolerance or multiple contraindications.

Read more:
Hypertension in SA
Diuretics

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