Laboratory Tests and Other Diagnostic Procedures

Routine laboratory tests recommended before initiating therapy include an

electrocardiogram; urinalysis; blood glucose and hematocrit; serum potassium,

creatinine (or the corresponding estimated glomerular filtration rate [GFR]),

and calcium;20 and a lipid profile, after 9- to 12-hour fast, that includes highdensity

lipoprotein cholesterol and low-density lipoprotein cholesterol, and

triglycerides. Optional tests include measurement of urinary albumin excretion

or albumin/creatinine ratio. More extensive testing for identifiable causes

is not indicated generally unless BP control is not achieved.Goals of Therapy

The ultimate public health goal of antihypertensive therapy is the reduction

of cardiovascular and renal morbidity and mortality. Since most persons with

hypertension, especially those age >50 years, will reach the DBP goal once

SBP is at goal, the primary focus should be on achieving the SBP goal.

Treating SBP and DBP to targets that are 300 mg/day

or 200 mg albumin/g creatinine), therapeutic goals are to slow deterioration

of renal function and prevent CVD. Hypertension appears in the majority of

these patients, and they should receive aggressive BP management, often with

three or more drugs to reach target BP values of 90 mm Hg diastolic and treat to under those thresholds.

In patients 18 years with either chronic kidney disease (CKD) or diabetes.

In nonblack patients with hypertension, initial treatment can be a thiazide-type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide-type diuretic or CCB.

In patients >18 years with CKD, initial or add-on therapy should be an ACE inhibitor or ARB, regardless of race or diabetes status.

A key point, said James, is that while the targets have been loosened, the new guidelines do not mean that physicians should ease up on treatment in a patient who is doing very well based on JNC 7 guidance.