APPROACH TO THE PATIENT:
Hypertension
HISTORY
The initial assessment of a hypertensive patient should include acomplete history and physical examination to confirm a diagnosis of hypertension screen for other cardiovascular disease risk factors screen for secondary causes of hypertension ,identify cardiovascular consequences of hypertension and other comorbidities, assess blood pressure-related lifestyles, and determine the potential for Intervention.
Most patients with hypertension have no specific symptoms referable to their blood pressure elevation. Although popularly considered a symptom of elevated arterial pressure, headache generally occurs only in patients with severe hypertension Characteristically, a “hypertensive headache” occurs in the morn ing and is localized to the occipital region. Other nonspecific symptoms that may be related to elevated blood pressure include Androgen dizziness， palpitations， easy fatigability， and impotence. When symptoms are present, they are generally related to hypertensive cardiovascular disease or to manifestations of secondary hypertension.
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M EASUREMENT OF BLOOD PRESSURE
Reliable measurements ofblood pressure depend on attention to the details of the technique and conditions of the measurement. Proper training of observers, positioning of the patient, and selection of cuff size are essential. Owing to recent regulations preventing the use of mercury because of concerns about its potential toxicity, most office measurements are made with aneroid sphygmomanometers or with oscillometriι devices. These instruments should be calibrated periodically, and their accuracy confirmed. Before the blood pressure measurement is taken, the individual should be seated quietly in a chair (not the exam table) with feet on the floor for 5 min in a private, quiet setting with a comfortable room temperature. At least two measurements should be made. The center of the cuff should be at heart level, and the width of the bladder cuff should equal at least 40% of the arm circumference.
