High Blood Pressure Diagnosis In The Modern Medical Landscape

High blood pressure can lead to many health complications and can be fatal if not addressed. Chronically high blood pressure increases the likelihood of stroke, organ failure, and other primary health conditions. As a diagnosis of this condition is vital, you have to consider the signs, symptoms, and etiology of high blood pressure.

High blood pressure diagnosis in the modern medical landscape

Blood pressure refers to the force blood applies against the inner walls of your blood vessels. High blood pressure (hypertension) occurs when the pressure inside your blood vessels remains consistently too high.

Hypertension is known as the "silent killer" because you may not notice anything amiss with your body even when the damage is ongoing.

However, if your blood pressure is extremely high, you may experience various symptoms that, at first glance, may be incorrectly diagnosed.

Multiple symptoms may contribute to hypertension. If you have increased vision changes, chest pains, fatigue, severe headaches, and breathlessness while undertaking activities you used to manage efficiently, you should visit your physician.

Even though hypertension is almost always asymptomatic, these signs may indicate the presence of associated medical conditions and should be checked out. The only way to determine if you have high blood pressure is to measure your blood pressure.

Risk factors for hypertension

Your clinician will ask questions concerning your medical history, check your risk factors, such as smoking or alcohol use, diabetes, high cholesterol, obesity, and other medical conditions. They will also discuss your family history — whether anyone in your family has had hypertension or is on blood pressure medicine.

Hypertension risk factors include:

• Chronically high blood pressure

• Obesity

• Poor diet

• Diabetes

• Physical inactivity

• Drug or alcohol use

• Family history of hypertension

How is blood pressure measured today?

The most common method for measuring blood pressure is with a blood pressure machine. Your blood pressure should be measured in a quiet place while you are sitting with both feet flat on the floor.

You can also check your blood pressure at home using a blood pressure monitor or at a drugstore by a healthcare professional.

Home measurements are beneficial for diagnosing and monitoring high blood pressure as they reflect what happens in your typical environment, rather than just a one-time reading at your physician's office. 

When you take your blood pressure at home, you should take the results for your doctor to it for accuracy and reliability against the clinic's readings.

Understanding your blood pressure reading

There are two numbers in your blood pressure reading:

• The systolic blood pressure is the top number and it reflects the highest pressure on the vessel walls whenever your heart contracts.

• The bottom number is the diastolic blood pressure, which occurs at the bottom of the cardiac cycle and measures the lowest pressure when your heart relaxes.

The pressure is recorded in millimeters of mercury (mm Hg).

These ranges are typically used to make a diagnosis:

Normal

• Systolic: < 120mm Hg

• Diastolic: < 80mm Hg

At-risk/ Prehypertension

• Systolic: 120–129mm Hg

• Diastolic: < 80mm Hg

High blood pressure/Hypertension

• Systolic: 130mm Hg or higher

• Diastolic: 80mm Hg or higher

Your blood pressure will vary based on age, activity, physical health, and other factors. One high measurement does not necessarily indicate that you have hypertension. If you have an elevated reading, it's a good idea to relax and repeat the measurement a few minutes after or later on in the day.

At least two or more readings on different days are typically required to make a definitive diagnosis.

Your healthcare professional will also perform a physical examination. They will use a stethoscope to listen for any unusual sounds in your heart that may suggest heart valve dysfunction or other abnormalities.

Your physician may also examine the pulses of your extremities to see how well the blood is flowing through the vessels.

Cardiac testing

If these preliminary findings indicate problems related to high blood pressure, your health professional may suggest additional testing, such as:

Electrocardiogram (ECG)

This is a test that uses electrodes placed on your legs, arms, and chest to evaluate the electrical impulses, rhythm, and pace of your heartbeat. The machine graphs the outcomes to produce a reading, which is carefully analyzed to make a diagnosis.

This test may rapidly determine the frequency and duration of each heartbeat phase. The ECG does not directly test for or diagnose hypertension but can report other cardiac irregularities.

To prepare for the ECG test, you aren't required to do anything in particular. You may consume food as usual before the procedure. You'll typically need to shed your upper garments, and you may be given a hospital robe to wear. Before the electrodes are affixed, your chest may require shaving or cleaning. The procedure typically takes a few minutes, and you can return to your regular activities immediately afterward.

ECGs are divided into three different types:

1.  A resting ECG is performed as you rest in a comfortable posture.

2.  A stress or exercise ECG is taken while exercising on a treadmill or stationary bike.

3. An ambulatory ECG (also known as a Holter monitor) uses electrodes attached to a compact machine strapped around your waist that continuously monitors your cardiac performance at home for one or more days.

The type of ECG administered depends on your symptoms and the possible cardiac condition.

ECG is a painless, rapid, and safe diagnostic modality. The ECG machine reads the electrical conduction in your heart during its cycle, and no electrical energy is introduced¹ into your body.

When the electrodes are removed from the skin's surface, they may cause some discomfort, akin to peeling an adhering bandage, and some individuals may notice some slight skin irritation where they were placed.

An exercise ECG is conducted under controlled settings. The technician performing the test will keep a close eye on you and halt the procedure if you develop any symptoms or feel unwell.

Echocardiogram

An echocardiogram (echo) is a procedure that uses ultrasound to generate images of the heart's chambers and valves and study its pumping motion. It also measures the chambers and wall thickness.

The echocardiogram can reveal cardiac abnormalities such as heart enlargement, irregularities in heart wall movements, blood flow, blood clots, and valve, vessel, and chamber anomalies. It also accurately assesses the heart muscle's functionality and pumping strength.

There are several types of echocardiograms:

• Transoesophageal echocardiogram. A tiny probe is sent through your mouth, down into your esophagus and stomach. First, your throat will be anesthetized and a calming sedative administered. You may need to avoid consuming food or drinks for a specified number of hours before the procedure.

• Stress echocardiogram. This type of echo is performed during or shortly after a treadmill or stationary bike workout or after receiving a drug infusion that causes your heart to exert itself.

• Contrast echocardiogram. A harmless chemical known as a contrast agent is infused into your circulation. It appears vividly on a scan and helps build a clearer image of your heart.

The type of echocardiogram you'll have will be determined by the heart disease being evaluated and the level of imaging detail required. For example, if physical exercise provokes your heart condition, a stress echocardiogram may be considered.

The comprehensive images provided by a transesophageal echocardiogram may be more beneficial for determining a specific diagnosis.

Ambulatory monitoring

Ambulatory monitoring refers to 24-hour blood pressure monitoring that can be used to determine if you have hypertension. The equipment employed for this procedure takes your blood pressure at periodic intervals for 24 hours, giving you a more realistic picture² of how your blood pressure varies throughout the day and night.

When it comes to self-assessments, patients must utilize proper blood pressure measurement equipment and techniques and validate the accuracy of their readings.

Lab tests

Your healthcare professional may recommend a range of biochemical tests, such as a urinalysis, and blood tests, including a cell count, chemistries, and lipids (like cholesterol), to evaluate for any associated conditions.

Doppler ultrasound

This technique is used to examine blood flow along the arteries at several pulse points in your legs, arms, and feet. Doppler ultrasound is a reliable method³ of detecting peripheral vascular disease prevalent in persons with hypertension.

Doppler ultrasound can also look at the arteries to both kidneys and reveal narrowing that can cause high blood pressure in a small proportion of patients.

In this non-invasive test, the health professional moves a small, hand-held instrument known as a transducer across the area to be evaluated. The device transmits sound waves into the test area, gathers and transmits them to a computer, which then builds images of your internal organs.

Arterial stiffness assessment

Arterial stiffness assessments are non-invasive procedures that evaluate the health of blood vessels. Hypertension causes vessels to stiffen, affecting the blood flow to the tissues and leading to vessel and organ damage. Assessing arterial stiffness can detect hypertension at a preliminary phase.⁴

Associated diagnostic factors

If your physician asks questions that may seem invasive, keep in mind that the facts you provide will lead to a more accurate diagnosis and an effective therapy.

Don't skirt around questions regarding alcohol use or other lifestyle choices. Tell the truth about how well you're adhering to your treatment plan and taking your medications.

Keeping information from your doctor can affect decision-making, impact the quality of your care, and perhaps even result in a missed diagnosis, which will often lead to health complications.

The lowdown

High blood pressure is a complicated medical condition that can cause various adverse effects across all parts of our bodies.

Understanding how this condition is diagnosed, the different diagnostic modalities, and the modern diagnostic process for hypertension help you in your discussions with your doctor.

Together, you and your healthcare provider can adopt a practical approach to diagnosis and treatment that will prevent hypertension complications.

Working closely with your healthcare professional in a spirit of collaboration helps you receive the highest standard of care for your medical condition.