What is Hypertension test? 

Blood pressure is the force that the circulating blood exerts on the walls of your arteries, a type of blood vessels. Each time your heart beats, it pumps more blood, the blood pressure is highest during this time and is called systolic pressure. Between heartbeats, your heart rests and blood pressure drops. This is called diastolic pressure. Your blood pressure reading shows both these values. If your reading is 120/80, it means that your systolic pressure is 120 and diastolic pressure is 80.

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If your systolic blood pressure is 140 or above or your diastolic pressure is 90 or above, you have high blood pressure or hypertension. Persistent hypertension needs clinical attention and should never be ignored. A blood pressure reading above 180/120, seek immediate medical attention. 

If you do not control your blood pressure, your heart has to work harder to pump blood. This can lead to serious problems like heart failure, stroke, heart attack and kidney failure. 

Hypertension is of two types:

  • Primary or essential hypertension: This is the most common type of hypertension. It develops as you grow older. 
  • Secondary hypertension: This is caused by the use of certain medicines or due to an underlying medical condition. It generally improves when you stop the medication or when the condition is treated.

A hypertension panel does not diagnose hypertension but detects problems that may cause or worsen hypertension. It includes the following tests:  

  • Urea: Urea test detects the amount of nitrogen present in your blood in the form of a waste product called urea. Urea is produced from protein breakdown in your body. It is filtered out through kidneys and is excreted in urine. Your blood urea level may rise if your kidneys are not functioning properly. It may also rise if you take a protein-rich diet, if you are dehydrated or have heart failure. This test is performed to check your kidney function. 
  • Creatinine: This blood test also checks kidney functioning. Creatinine is a waste product of muscle metabolism that is released into the bloodstream constantly as you use your muscles. Most of this creatinine is eliminated in the urine through the process of filtration. Creatinine levels rise when there is kidney damage.
  • Sodium: Sodium test checks the sodium levels in blood. Sodium is a mineral that is needed for the normal functioning of all cells in body, especially the muscles and nerves. Sodium levels are maintained by kidneys, all the excess sodium is eliminated in urine. However, when you consume too much sodium, your kidneys cannot eliminate enough of it. This leads to sodium build-up in the body, which causes hypertension.
  • Potassium: Potassium is yet another mineral that, along with sodium, helps maintain the fluid and electrolyte balance in your body. It also plays an important role in maintaining heart function, muscle contraction, and nerve conduction. A potassium test checks for the blood levels of potassium. Most of the potassium is present inside body cells, but a small quantity is also present in the bloodstream. Excess potassium is eliminated in the urine. If you have any problem in your kidneys, your blood potassium levels will rise.
  • Chloride: This test checks for the amount of chloride (a type of chlorine) in your blood. Chloride balances the amount of fluid present inside and outside the cells. It also maintains blood pressure and blood volume in the body.
  • Lipid profile: A lipid profile consists of a set of tests that checks the levels of cholesterol and other fats in your blood. It measures the total cholesterol, LDL cholesterol (low-density lipoprotein or “bad” cholesterol), HDL cholesterol (high-density lipoprotein or “good” cholesterol) and triglycerides (another type of fat that causes arteries to harden). If cholesterol and triglycerides build up in blood, they can clog arteries. A clogged artery in the heart muscle may affect the functioning of the heart and lead to a stroke. This profile can help in predicting your risk of heart disease and stroke.
  • Urine 24-hour (24h) protein: This test checks for the presence and amount of protein in your urine. Normally, your kidneys filter the protein and send it back to your circulation. However, when your kidneys are not functioning properly, proteins are lost in the urine. Proteins in urine can be due to different conditions, including diabetes and kidney disease. If you have proteins in your urine during pregnancy, it could be an indication of a dangerous condition called preeclampsia (extremely high blood pressure).

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  1. Why is a Hypertension test performed?
  2. How do you prepare for a Hypertension test?
  3. How is a Hypertension test performed?
  4. What do the Hypertension test results mean?

Your doctor may order this panel to detect conditions that may cause hypertension or worsen it. This test may also be performed to evaluate and monitor the functioning of various organs.

Hypertension does not have any warning symptoms. It is called a “silent killer”. Therefore, it is essential to get your blood pressure checked regularly. However, if symptoms occur, they include:

If you have severe hypertension, you may have the following symptoms:

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Inform your doctor if you are taking any drugs. This includes non-prescription medicines, herbs, vitamins, supplements and illegal drugs.

For the urea blood test, your results may be affected if you:

  • Are consuming a diet that is high in proteins 
  • Are taking steroids
  • Are dehydrated 
  • Are older
  • Have burns

For the creatinine test, inform your doctor if you are pregnant as it may affect your test results. Having large amounts of meat and taking large doses of vitamin C also affect the results of a creatinine test. The doctor may ask you to temporarily discontinue drugs like cimetidine, ranitidine, famotidine and certain antibiotics, such as trimethoprim, as they can affect the results.

For the sodium test, you may need to avoid food and water for several hours before the test. High blood sugar levels may affect the test results. Your doctor may ask you to stop certain medicines as they may affect the test results. These include: 

  • Lithium
  • Antibiotics
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Diuretics (water pills)
  • Antidepressants 
  • Certain drugs for hypertension

You do not need to prepare for the potassium test. Your doctor may ask you to discontinue certain medicines that may affect the test results. These include:

  • Certain diuretics called potassium-sparing diuretics
  • Mannitol
  • Heparin
  • Amphotericin B
  • Cisplatin
  • Isoniazid
  • Insulin
  • Penicillin G
  • Laxatives

If you have been administered an infusion of glucose, insulin or potassium-containing fluids, your test results may be affected.

Drinks that contain caffeine may cause bloating and/or water loss and affect the amount of chloride in the body. Chloride levels may fall if you lose large volumes of fluid due to vomiting or diarrhoea. Let your doctor know if you have either of the problems.

For the lipid profile, you will need to fast for 12-14 hours before the test, but you may have water. If you are under stress or are sick, your test results may be affected. The food you eat, how frequently you exercise and whether you smoke also affect the test results. Talk to your doctor to know more about it.

The urine 24h protein test results may be affected by certain factors, such as:

Inform your doctor if you have been unwell recently or had a fever. You may need to discontinue exercising for a certain duration before the test.

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The urea, creatinine, sodium, potassium, chloride and lipid profile are blood tests. A technician will collect a blood sample from a vein in your arm to perform the test.

You may get mild bruising after the test. However, it would fade on its own in a few days. If you notice an infection developing at the needle insertion site, make sure to talk to your doctor as soon as possible.

For a urine 24h protein test you will have to collect a sample of your urine over a period of 24 hours. Your doctor will give you a special container to collect the urine. Here is how 24h urine sample collected:

  • Start collecting the urine early in the morning. However, on day 1, do not collect the first urine of the day. 
  • Over the next 24 hours, collect all the urine in the container provided by your doctor or the laboratory. 
  • Keep the container closed and store it in a cool place or the refrigerator during the collection period. 
  • On day 2, collect the first urine of the morning.
  • Label the container and return it as instructed. 

There is no discomfort associated with this procedure.

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Normal results:

Normal values for the tests in the hypertension panel are as follows:

  • Urea: 7-21 mg/dL (milligrams per decilitre)
  • Creatinine: 0.7-1.3 mg/dL for men and 0.6-1.1 mg/dL for women
  • Sodium: 136-145 mmol/L (millimoles per litre)
  • Potassium: 3.7-5.2 mEq/L (milliequivalents per litre)

Normal chloride levels in different age groups are as follows: 

  • Adults: 98-106 mEq/L 
  • Children: 90-110 mEq/L 
  • Newborns: 96-106 mEq/L 
  • Premature babies: 95-110 mEq/L
  • Urine 24h protein: Less than 100 mg per day or less than 10 mg/dL of urine
  • Normal values for lipid profile are as follows:
    • Total cholesterol: Less than 200 mg/dL
    • LDL cholesterol: Less than 100 mg/dL
    • HDL cholesterol: Above 40 mg/dL
    • Triglycerides: Less than 150 mg/dL

Abnormal results:

Generally, urea levels alone are not enough to diagnose kidney disease unless they are higher than 60 mg/dL. To evaluate kidney function, doctors usually look at how your urea and creatinine levels compare.

Abnormal creatinine levels may indicate conditions like hypertension, preeclampsia, dehydration and kidney problems.

High sodium levels (hypernatraemia) can cause hypertension.

High potassium levels are seen in kidney disease. Low potassium levels can cause irregular heartbeats, while high potassium levels can decrease heart muscle activity. Both situations can be life-threatening.

Abnormal chloride levels may be an indication of improper kidney functioning.

High LDL cholesterol and triglyceride levels suggest a higher risk of heart disease. On the other hand, the high HDL levels are usually associated with a lower risk of heart disease.

Abnormal urine 24h protein levels could indicate conditions such as preeclampsia, heart failure and kidney disease due to hypertension, diabetes or other causes.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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References

  1. MedlinePlus Medical Encyclopedia [Internet]. US National Library of Medicine. Bethesda. Maryland. USA; High Blood Pressure
  2. American Heart Association [internet]. Dallas. Texas. U.S.A.; 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
  3. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; High Blood Pressure
  4. American Academy of Family Physicians [Internet]. Leawood (KS). US; AAFP Decides to Not Endorse AHA/ACC Hypertension Guideline
  5. Michigan Medicine: University of Michigan [internet]. US; Blood Urea Nitrogen
  6. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Adult and Children's Health Encyclopedia
  7. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Hypertension
  8. Chernecky CC, Berger BJ. Creatinine - serum. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:399.
  9. Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 114.
  10. Inker LA, Fan L, Levey AS. Assessment of renal function. In: Johnson RJ, Feehally J, Floege J, eds. Comprehensive Clinical Nephrology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3.
  11. UCSF health: University of California [internet]. US; Serum Sodium
  12. Benioff Children's Hospital [internet]. University of California. San Francisco. US; Potassium Test
  13. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Acidosis
  14. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Chloride, Serum; p. 153–4.
  15. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Overview of Acid-Base Balance
  16. Merck Manual Professional Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2019. Endocrine and Metabolic Disorders
  17. UCSF health: University of California [internet]. US; 24-hour Urine Protein

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