title: Hypertension: The role of biochemistry in the diagnosis and management.
abstract: Hypertension is defined as a persistently elevated blood pressure ≥140/90mmHg. It is an important treatable risk factor for cardiovascular disease, with a high prevalence in the general population. The most common cause, essential hypertension, is a widespread disease - however, secondary hypertension is under investigated and under diagnosed. Collectively, hypertension is referred to as a "silent killer" - frequently it displays no overt symptomatology. It is a leading risk factor for death and disability globally, with >40% of persons aged over 25 having hypertension. A vast spectrum of conditions result in hypertension spanning essential through resistant, to patients with an overt endocrine cause. A significant number of patients with hypertension have multiple cardiovascular risk factors at the time of presentation. Both routine and specialised biochemical investigations are paramount for the evaluation of these patients and their subsequent management. Biochemical testing serves to identify those hypertensive individuals who are at higher risk on the basis of evidence of dysglycaemia, dyslipidaemia, renal impairment, or target organ damage and to exclude identifiable causes of hypertension. The main target of biochemical testing is the identification of patients with a specific and treatable aetiology of hypertension. Information gleaned from biochemical investigation is used to risk stratify patients and tailor the type and intensity of subsequent management and treatment. We review the approach to the biochemical investigation of patients presenting with hypertension and propose a diagnostic algorithm for work-up.
authors.affiliation: Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland. Electronic address: paulam.oshea@hse.ie.
authors.forename: P M
authors.initials: PM
authors.lastname: O'Shea
authors.affiliation: Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.
authors.forename: T P
authors.initials: TP
authors.lastname: Griffin
authors.affiliation: Dept. of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Fitzgibbon
mesh_terms: D000172:Acromegaly / Q000150:complications; D000328:Adult; D019963:Clinical Chemistry Tests / Q000379:methods*; D003480:Cushing Syndrome / Q000150:complications; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D020181:Sleep Apnea, Obstructive / Q000150:complications
keywords: Biochemical investigations; Hypertension; Pre-analytical; Secondary hypertension