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. 2023 Dec 19;31(6):641–853. doi: 10.5551/jat.GL2022

Table 16. Step 1c Determine the need for referral to a specialist.

(1) If the patient is suspected to have a history or is complicated with stroke/transient ischemic attack (TIA), coronary artery disease (CAD), arrhythmia (such as atrial fibrillation), aortic disease, or peripheral arterial disease (PAD)
(2) Hypertension
Suspected secondary hypertension (early incidence, acute incidence, etc.), pregnancy‐induced hypertension, hypertensive emergency or urgency (untreated diastolic blood pressure ≥ 120 mmHg), treatment‐resistant hypertension (≥ 180/110 mmHg despite treatment or not achieving antihypertensive goal even with concomitant therapy with 3 drugs)
(3) Diabetes mellitus
Type 1 DM, HbA1c ≥ 8.0%, fasting blood glucose ≥ 200 mg/dL (or non‐fasting blood glucose ≥ 300 mg/dL), acute complications (hyperglycemic emergency), or gestational diabetes
(4) Dyslipidemia:
LDL‐C ≥ 180 mg/dL, HDL‐C <30 mg/dL, fasting TG ≥ 500 mg/dL, non‐HDL‐C ≥ 210 mg/dL, or suspected primary hyperlipidemia or secondary dyslipidemia
(5) Chronic kidney disease (CKD):
CKD patients with proteinuria and hematuria
eGFR <45 ml/min/1.73 m2 (G3b to 5 ) or proteinuria category A3 (urine albumin/ Cr ratio >300 mg/gCr in diabetes, urine protein/ Cr ratio >0.5 g/Cr otherwise). For patients under 40 years of age or in the A2 category (Urine albumin/Cr ratio 30-299 mg/gCr for diabetes, urine protein/Cr ratio 0.15-0.49 g/Cr for other conditions), referral should be made even if the eGFR is 45-59.
(6) Obesity:
Severe obesity (BMI ≥ 35). Suspected secondary obesity (symptomatic obesity)