7th Brazilian Guideline of Arterial Hypertension: Chapter 3 - Clinical and Complementary Assessment

The major objectives of clinical and laboratory assessment are shown in Chart 1. Meeting those goals allows the correct AH diagnosis and prognosis, enabling choosing the better therapy for the patient. Clinical history Complete clinical history with questions about time since AH diagnosis, course and previous treatment should be obtained. Information on the family history is essential to increase the chance of an accurate diagnosis of primary AH. 1 (GR: I; LE: B). The patient should be asked about specific RF for CVD, comorbidities, socioeconomic aspects and lifestyle, 2 in addition to previous and current use of medications or other substances that can interfere with BP measurement and/or AH treatment. Similarly, evidence of a secondary cause of AH should be investigated. Physical examination Blood pressure should be measured with proper technique (Chapter 2). Anthropometric data, such as weight, height [for body mass index (BMI) calculation], abdominal circumference (AC) and heart rate (HR), should be recorded. The normal values of AC and BMI are those recommended by the International Diabetes Federation (IDF) in 2006, and can vary according to ethnicity. Assessment (Chart 2) should comprise palpation and auscultation of the heart, carotid arteries and pulses, ankle-brachial index (ABI) measurement and retinal exam. To calculate ABI, measure SBP in the arm and ankle, in both sides. An arm SBP/ankle SBP ratio greater than 0.90 is defined as normal, while PAD is defined as mild, if that ratio is 0. Basic laboratory investigation, assessment of subclinical and clinical target-organ damage Complementary assessment is aimed at detecting subclinical or clinical TOD to better stratify CV risk. To stratify global CV risk, the classical RF (Chart 3), as well as Chart 1 – Objectives of clinical and laboratory assessment