Gifford R W, Kirkendall W, O'Connor D T, Weidman W
American Heart Association, Office of Scientific Affairs, Dallas, TX 75231.
Circulation. 1989 Mar;79(3):721-31. doi: 10.1161/01.cir.79.3.721.
The ultimate purpose of office evaluation of the hypertensive patient is to provide optimal management of blood pressure and associated risk factors. The workup includes a valid estimate of average blood pressure, including home blood pressure measurements, assessment of the degree of target organ damage, and identification of other risk factors, including family history. The history and physical examination should be directed to the principal target organs, including the optic fundi, central nervous system, heart, and kidneys. Laboratory evaluation should include urinalysis, ECG, and determinations of blood hemoglobin/hematocrit, creatinine, potassium, glucose, and cholesterol, including HDL fraction. This information will alert the physician to the possibility of curable forms of hypertension such as coarctation of the aorta, pheochromocytoma, primary aldosteronism, and renovascular hypertension. The office evaluation is also concerned with estimating prognosis and extent of organic damage, which is essential in planning management. The nurse or trained allied health professional should be used to the fullest possible extent both in evaluation and management of hypertensive patients.
对高血压患者进行门诊评估的最终目的是提供血压及相关危险因素的最佳管理。检查包括对平均血压的有效评估，包括家庭血压测量、靶器官损害程度的评估，以及其他危险因素的识别，包括家族史。病史和体格检查应针对主要靶器官，包括眼底、中枢神经系统、心脏和肾脏。实验室评估应包括尿液分析、心电图，以及血液血红蛋白/血细胞比容、肌酐、钾、葡萄糖和胆固醇（包括高密度脂蛋白部分）的测定。这些信息将提醒医生注意可治愈的高血压形式的可能性，如主动脉缩窄、嗜铬细胞瘤、原发性醛固酮增多症和肾血管性高血压。门诊评估还涉及估计预后和器质性损害的程度，这对规划管理至关重要。在高血压患者的评估和管理中，应尽可能充分地利用护士或训练有素的专职医疗人员。
