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Abstract
This review focuses on the laboratory biochemical tests that are useful in the diagnostic approach to the hypertensive patient. A “minimal” diagnostic laboratory work-up, including a small number of tests that are simple and relatively inexpensive, is first described. Because these tests provide basic information on the presence of major cardiovascular (CV) risk factors and target organ damage, and might give some clues to the presence of a secondary form of hypertension (HT), they should be performed on all patients presenting with HT. Other tests that are aimed at assessing the overall CV risk, a major determinant of prognosis that dictates the therapeutic strategy in the individual HT patient, are then discussed. They allow identification of major CV risk factors and associated clinical conditions which, if present, lead to a substantial change of therapeutic strategy. The role of C-reactive protein as a marker of atherosclerosis and its predictive value for CV events are also discussed. Finally, a section is devoted to tests that are currently confined to research purposes, such as markers of endothelial function including endothelin-1, homocysteine and genetic analysis.
| Abbreviations | ||
| ANP, | = | atrial natriuretic peptide; |
| Apo B, | = | apolipoprotein B; |
| ASCOT, | = | Anglo-Scandinavian Cardiac Outcomes Trial; |
| ATP III, | = | Adult Treatment Panel III; |
| BNP, | = | brain natriuretic peptide; |
| BP, | = | blood pressure; |
| CARDS, | = | Collaborative Atorvastatin Diabetes Study; |
| CHD, | = | coronary heart disease; |
| CRP, | = | C-reactive protein; |
| CV, | = | cardiovascular; |
| DM, | = | diabetes mellitus; |
| EDCFs, | = | endothelium-derived constricting factors; |
| EDRFs, | = | endothelium-derived relaxing factors; |
| EIA, | = | enzyme immunoassay; |
| ELISA, | = | enzyme-linked immunosorbent assay; |
| ESC, | = | European Society of Cardiology; |
| ESH, | = | European Society of Hypertension; |
| ET-1, | = | endothelin-1; |
| GFR, | = | glomerular filtration rate; |
| HbA1c, | = | glycosylated haemoglobin; |
| Hcy, | = | homocysteine; |
| HDL-C, | = | high density lipoprotein cholesterol; |
| HHcy, | = | hyperhomocysteinemia; |
| HOMA, | = | homeostasis model assessment; |
| HOPE, | = | Heart Outcomes Prevention Evaluation; |
| HPS, | = | Heart Protection Study; |
| (hs)CRP, | = | high-sensitivity CRP; |
| HT, | = | arterial hypertension; |
| ICAM-1, | = | intercellular adhesion molecule-1; |
| IGT, | = | impaired glucose tolerance; |
| IL, | = | interleukin; |
| IRMA, | = | immunoradiometric assay; |
| K/DOQI, | = | Kidney Disease Outcomes Quality Initiative; |
| LDL-C, | = | low density lipoprotein cholesterol; |
| Lp(a), | = | lipoprotein(a); |
| MDRD Study, | = | Modification of Diet in Renal Disease Study; |
| NCEP, | = | National Cholesterol Educational Program; |
| NHANES, | = | National Health and Nutrition Survey; |
| NO, | = | nitric oxide; |
| NT-proBNP, | = | N-terminal pro BNP; |
| OGTT, | = | oral glucose tolerance test; |
| PROVE IT, | = | PRavastatin Or atorVastatin Evaluation and Infection Therapy; |
| RIA, | = | radioimmunoassay; |
| SCORE, | = | Systematic Coronary Risk Evaluation; |
| TNFα, | = | tumour necrosis factor-α; |
| UAE, | = | urinary albumin excretion; |
| VCAM-1, | = | vascular adhesion molecule-1; |
| VLDL, | = | very low-density lipoproteins. |
| Abbreviations | ||
| ANP, | = | atrial natriuretic peptide; |
| Apo B, | = | apolipoprotein B; |
| ASCOT, | = | Anglo-Scandinavian Cardiac Outcomes Trial; |
| ATP III, | = | Adult Treatment Panel III; |
| BNP, | = | brain natriuretic peptide; |
| BP, | = | blood pressure; |
| CARDS, | = | Collaborative Atorvastatin Diabetes Study; |
| CHD, | = | coronary heart disease; |
| CRP, | = | C-reactive protein; |
| CV, | = | cardiovascular; |
| DM, | = | diabetes mellitus; |
| EDCFs, | = | endothelium-derived constricting factors; |
| EDRFs, | = | endothelium-derived relaxing factors; |
| EIA, | = | enzyme immunoassay; |
| ELISA, | = | enzyme-linked immunosorbent assay; |
| ESC, | = | European Society of Cardiology; |
| ESH, | = | European Society of Hypertension; |
| ET-1, | = | endothelin-1; |
| GFR, | = | glomerular filtration rate; |
| HbA1c, | = | glycosylated haemoglobin; |
| Hcy, | = | homocysteine; |
| HDL-C, | = | high density lipoprotein cholesterol; |
| HHcy, | = | hyperhomocysteinemia; |
| HOMA, | = | homeostasis model assessment; |
| HOPE, | = | Heart Outcomes Prevention Evaluation; |
| HPS, | = | Heart Protection Study; |
| (hs)CRP, | = | high-sensitivity CRP; |
| HT, | = | arterial hypertension; |
| ICAM-1, | = | intercellular adhesion molecule-1; |
| IGT, | = | impaired glucose tolerance; |
| IL, | = | interleukin; |
| IRMA, | = | immunoradiometric assay; |
| K/DOQI, | = | Kidney Disease Outcomes Quality Initiative; |
| LDL-C, | = | low density lipoprotein cholesterol; |
| Lp(a), | = | lipoprotein(a); |
| MDRD Study, | = | Modification of Diet in Renal Disease Study; |
| NCEP, | = | National Cholesterol Educational Program; |
| NHANES, | = | National Health and Nutrition Survey; |
| NO, | = | nitric oxide; |
| NT-proBNP, | = | N-terminal pro BNP; |
| OGTT, | = | oral glucose tolerance test; |
| PROVE IT, | = | PRavastatin Or atorVastatin Evaluation and Infection Therapy; |
| RIA, | = | radioimmunoassay; |
| SCORE, | = | Systematic Coronary Risk Evaluation; |
| TNFα, | = | tumour necrosis factor-α; |
| UAE, | = | urinary albumin excretion; |
| VCAM-1, | = | vascular adhesion molecule-1; |
| VLDL, | = | very low-density lipoproteins. |