Pre-treatment examinations: Medical history and physical examination
Hypertension and its consequences are largely controllable and preventable. Certain examinations will be done to determine the best management plan for you.
The purpose of the pre-treatment examination
Your doctor will ask you a lot of questions as part of the pre-treatment examination - all to determine the possible cause of your hypertension, establish your type of hypertension and to choose the best treatment option for you. When the doctor takes your medical history and performs the physical examination, he/she will try to establish the following:
1. Is there a curable cause for your high blood pressure?
The majority of people suffer from essential hypertension that has no obvious cause. Primary or essential hypertension can be controlled with lifestyle modification and sometimes, added medication.
However, 5 – 10 % of patients have secondary hypertension, with an identifiable cause. This type of hypertension can sometimes be cured with surgery or successfully treated with medication.
White coat hypertension also needs to be ruled out. In this condition there is no sustained raise in blood pressure when readings are done outside of the clinical setting.
2. Are there other cardiovascular risk factors?
Hypertension is an important risk factor for heart attacks, heart failure, strokes and other cardiovascular complications. Many other risk factors have been identified, and your total risk increases when any of those are present.
The risk assessment will effect the need for, and choice of treatment. The major risk factors include: smoking, elevated blood fats, diabetes and a family history of premature heart problems or strokes. Risk also increases with age and is higher in men and postmenopausal women.
3. What other contributory factors and lifestyle habits can be identified?
Lifestyle modification can have a great impact on your blood pressure. Some patients are able to control their hypertension without drugs, by changing their habits. This also decreases overall cardiovascular risk.
Smokers that suffer from hypertension and high cholesterol are dancing with death.
Losing excess weight has been found to be the most effective way of lowering blood pressure, without using medication.
A low salt diet is essential as many people are salt sensitive.
Increasing your potassium intake helps to eliminate salt and is of general benefit to your cardiovascular system, as is calcium and magnesium.
A low fat, low salt, whole grain diet, with plenty of fruit and vegetables and low fat dairy is recommended.
Drinking habits can also affect blood pressure, especially if heavy drinking is a regular event.
Couch potatoes are also urged to start exercising. Walking 20 minutes, four times a week is a good start.
4. Is there any target organ damage present?
Hypertension can damage certain organs and the status of these target organs must be assessed. These include the retina of the eyes, the kidneys and other blood vessels, especially in the lower legs.
The brain is also a target organ and history of a previous stroke or “mini-strokes” is very important.
Hypertension causes damage to the heart and its vessels, including heart failure and enlargement of the left heart chamber. Important complications of hypertension are a history of angina, previous heart attack or bypass surgery.
5. Are there any conditions or diseases that could affect choice of drugs?
People with asthma cannot use certain anti-hypertensive drugs, called beta-blockers.
Thiazide diuretics can worsen gout in some individuals.
Patients with kidney problems will require different dosages.
Diabetics and people with heart failure do better on ACE inhibitors. Beta-blockers are considered if there had been a previous heart attack.
Only certain drugs are allowed during pregnancy. (see anti-HPT drugs)
(Dr Kathleen Coetzee, MBChB)
Hypertension and your weight
Risk factors you can't control