| Chest X-ray: indicated for follow-up of hypertensive patient in case of clinical suspicion of cardiac involvement (LR: IIa, LE: C) and/or pulmonary involvement and to assess hypertensive patients with aortic involvement for whom an echocardiogram is not available.
262
|
| Echocardiogram: more sensitive than an electrocardiogram to diagnose left ventricular hypertrophy (LVH), adds value in the assessment of the geometry of left atrial hypertrophy and size of the left atrium, as well as analysis of systolic and diastolic function. Indicated when there are signs of LVH in the electrocardiogram or for patients with clinical suspicion of heart failure (LR: IIa, LE: B). LVH is diagnosed when the left ventricular mass adjusted for body surface area is equal to or greater than 116 g/m
2
for men and 96 g/m
2
for women.
263
|
| Albuminuria or urine protein/creatinine ratio or urine albumin/creatinine ratio: useful test for diabetic hypertensive patients, patients with metabolic syndrome or two or more risk factors, since it is predictive of fatal and nonfatal cardiovascular events (normal values < 30 mg/g of creatinine (LR: I, LE: B).
264
|
| Carotid ultrasound: indicated in the presence of carotid bruit, signs of cerebrovascular disease, or presence of atherosclerotic disease in other areas. Increased carotid intima-media thickness (IMT) and/or the identification of atherosclerosis plaque formation is predictive of stroke and myocardial infarction, regardless of other CV risk factors. IMT values > 0.9 mm are considered abnormal, as is the finding atherosclerotic plaques (LR: I, LE: A).
265
,
266
|
| Doppler or non-Doppler renal ultrasound: necessary for patients with abdominal masses or abdominal murmur (LR: IIa, LE: B).
267
|
| Glycated hemoglobin (HbA1c): indicated when fasting plasma glucose is higher than 99 mg/dL, family history or previous diagnosis of type 2 DM and obesity (LR: IIa, LE: B).
268
|
| Exercise stress test: indicated in suspected stable coronary disease, diabetes mellitus or family history of coronary disease in patients with controlled blood pressure (LR: IIa, LE: C).
269
|
| ABPM/HBPM: see indications for methods in Chapter 3 (LR: I, LE: A).
186
|
| Pulse wave velocity (PWV) measurement, when available: indicated for low- to moderate-risk hypertensives, considered a useful method to assess arterial stiffness, ie, vascular damage. PWV values higher than 10m/s are considered abnormal for the general population, but there are adjusted reference values for age and sex deciles available (LR: IIa, LE: A).
139
,
270
,
271
|
| Brain magnetic nuclear resonance (MNR): indicated in patients with cognitive disorders and dementia to detect silent cerebral infarcts and microbleeds (LR: IIa, LE: C).
272
|
