2010 Hong Kong Reference Framework for Hypertension Care for ...

to assess lifestyle and identify cardiovascular risk factors that may affect prognosis and guide treatment,to reveal identifiable causes of high blood pressure, andto assess the presence Module or absence 4 Evaluation of target organ for All damage Newly and Diagnosed cardiovascular Hypertensive disease. (Box Patients 1)11 Target organ damagetorySymptoms suggestive The aims of of secondary the evaluation causes are:Symptoms (present • to or assess past history) lifestyle of and cardiovascular identify cardiovascular risk factors: risk age>55 factors for that men may and affectage>65 for women/ smokinor women under age prognosis 65) and guide treatment,Target organ damage: • to reveal retinopathy/ identifiable left ventricular causes of hypertrophy/ high blood pressure, heart failure/ andcoronary heart disease (CHD)/ proteFactors that affect • choice to assess of drug the presence treatment or like absence gout, of bronchospasm.target organ damage and cardiovascularAssessment of lifestyle: disease. exercise, (Box 1)diet, alcoholDrug historyPsychosocial factors Box 1 Target organ damage 2Family history: hypertension• Heart: Left (HT),ventricular diabetes,hypertrophy stroke, renal(ECG disease,/ Echocardiogram)myocardial infarction and other cardiovascular• Renal: Albuminuria and / or elevation of plasma creatinine (>110 µmol/L)sical examination• Vessel: USG or radiological evidence of atherosclerotic plaque (carotid,Body weight, height,iliac, Bodyfemoral Mass Indexor aorta), generalised or focal narrowing of the retinalFeatures of Cushing’sarteriessyndrome / Acromegaly (endocrine case of HT)Skin stigmata of neurofibromatosis‣ ¾ Angina or (phaeochromocytoma)prior myocardial infarctionRadial/brachial femoral delay, precordial or chest murmurs (aortic coarctation or aortic disease)‣ ¾ Prior coronary revascularisationAbdominal examination: enlarged kidney, abdominal bruit‣ ¾ Heart failureSigns of organ damage: peripheral arterial disease, fundi abnormalities, carotid bruit, neurological defects, CVS ex• Brain:‣ ¾ Stroke or transient ischaemic attacktine laboratory investigation‣ ¾ Dementia• Chronic renal disease• Peripheral arterial disease• Retinopathy: Hemorrhages or exudates, Papilloedema1 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings