Clinical Department for Laboratory Diagnostics, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
Department of Medical Informatics, Rijeka University School of Medicine, Rijeka, Croatia.
Biochem Med (Zagreb). 2023 Feb 15;33(1):010501. doi: 10.11613/BM.2023.010501.
In the initial diagnostics of arterial hypertension (AH) laboratory medicine is a cornerstone, along with a blood pressure (BP) measurement and an electrocardiogram. It mainly refers to routine blood and urine tests for diagnosis and monitoring primary hypertension and its associated conditions such as asymptomatic hypertension-mediated organ damage, chronic kidney disease and hypertensive disorders of pregnancy. In addition, long term non-fatal and fatal risks for cardiovascular (CV) events in hypertension are assessed based on clinical and laboratory data. Furthermore, laboratory medicine is involved in the management of hypertension, especially in monitoring the disease progression. However, antihypertensive drugs may interfere with laboratory test results. Diuretics, especially thiazides, can affect blood and urine sodium concentrations, or angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can affect the blood biomarkers of the renin-angiotensin-aldosterone system (RAAS). It's dysfunction plays a critical role in primary aldosteronism (PA), the most common endocrine disorder in secondary hypertension, which accounts for only small proportion of AH in relative terms but substantial proportion of hypertensives in absolute terms, affecting younger population and carrying a higher risk of CV mortality and morbidity. When screening for PA, aldosterone-to-renin ratio still contributes massively to the increased incidence of the disease, despite certain limits. In conclusion, laboratory medicine is involved in the screening, diagnosis, monitoring and prognosis of hypertension. It is of great importance to understand the preanalytical and analytical factors influencing final laboratory result.
在动脉高血压（AH）的初始诊断中，实验室医学是一个基石，与血压（BP）测量和心电图一起。它主要指的是诊断和监测原发性高血压及其相关病症的常规血液和尿液检查，如无症状高血压介导的器官损伤、慢性肾脏病和妊娠高血压疾病。此外，根据临床和实验室数据评估高血压的长期非致命和致命心血管（CV）事件风险。此外，实验室医学还参与高血压的管理，尤其是在监测疾病进展方面。然而，降压药物可能会干扰实验室测试结果。利尿剂，尤其是噻嗪类药物，会影响血液和尿液中的钠浓度，或血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂会影响肾素-血管紧张素-醛固酮系统（RAAS）的血液生物标志物。它的功能障碍在原发性醛固酮增多症（PA）中起着关键作用，PA 是继发性高血压中最常见的内分泌紊乱，相对于 AH 的比例较小，但绝对数量的高血压患者比例较大，影响年轻人群，并且 CV 死亡率和发病率较高。在筛查 PA 时，尽管存在一定的局限性，但醛固酮与肾素比值仍然对该病的发病率有很大的影响。总之，实验室医学参与高血压的筛查、诊断、监测和预后。了解影响最终实验室结果的分析前和分析因素非常重要。
