Chapter 5: How High Blood Pressure is Diagnosed

Part 2: Testing, Diagnosis, and Monitoring

Diagnosing high blood pressure is one of the simplest yet most essential steps in preventing heart disease, stroke, and kidney damage. Since hypertension often goes unnoticed, regular blood pressure checks and thorough evaluation by healthcare professionals are key to early detection and intervention.

In this chapter, we’ll cover:

• Why regular blood pressure screenings are so important

• How to understand blood pressure numbers

• The tools and tests doctors use to confirm a hypertension diagnosis

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1. The Importance of Regular Blood Pressure Checks

Why Monitor Blood Pressure Frequently?

High blood pressure is called the “silent killer” for a reason—it typically causes no symptoms but steadily damages the heart, blood vessels, kidneys, and brain over time. The only way to catch it early is through consistent monitoring.

Who Should Check Their Blood Pressure?

✅ Adults over age 18 (especially after 40)
✅ People with a family history of hypertension or cardiovascular disease
✅ Individuals who are overweight or obese
✅ Those with diabetes, high cholesterol, or kidney issues
✅ Pregnant women (to monitor for pre-eclampsia)
✅ People who experience frequent headaches, dizziness, or fatigue

How Often Should You Get Checked?

• Normal BP (less than 120/80): Every 1-2 years

• Elevated BP (120–129/<80): Every 3-6 months

• Stage 1 or 2 Hypertension (130+/80+): Every 1–4 weeks, or as advised by your doctor

• Home monitoring is encouraged for people at risk or already diagnosed

Tip: Many pharmacies, grocery stores, and health clinics offer free or low-cost BP checks—take advantage of them.

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2. Understanding Blood Pressure Readings

Blood pressure is measured in millimeters of mercury (mmHg) and recorded as two numbers:

• Systolic pressure (top number) – the pressure in your arteries when your heart beats

• Diastolic pressure (bottom number) – the pressure when your heart rests between beats

Blood Pressure Categories (American Heart Association):

Example: A reading of 145/95 mmHg would be classified as Stage 2 Hypertension.

What Affects Blood Pressure Readings?

• Time of day

• Stress or anxiety

• Physical activity

• Caffeine, alcohol, or tobacco

• Full bladder

• Improper positioning or talking during the reading

Best Practices for Accurate Readings:

• Sit quietly for 5 minutes before measuring

• Rest your arm on a table at heart level

• Avoid caffeine, alcohol, or smoking for 30 minutes beforehand

• Take multiple readings, ideally at the same time each day

• Use a clinically validated monitor for home use

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3. How Doctors Evaluate Hypertension

Doctors go beyond a single blood pressure reading to determine if a person truly has high blood pressure or if it’s a temporary spike due to stress, illness, or anxiety (also known as white coat syndrome).

a) Repeated Blood Pressure Measurements

• BP is measured on multiple occasions, at different times and settings.

• If consistently high, a diagnosis of hypertension may be made.

• Ambulatory blood pressure monitoring (ABPM) may be used—this device tracks your BP over 24 hours to catch fluctuations and confirm diagnosis.

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b) Medical History and Physical Exam

Your doctor will ask about:

• Family history of hypertension or cardiovascular disease

• Symptoms like headaches, fatigue, blurred vision

• Lifestyle factors: diet, exercise, stress, alcohol, smoking

• Medications or supplements you’re taking

• Past medical issues (diabetes, kidney problems, cholesterol)

A physical exam may include:

• Listening to your heart and lungs

• Checking for swelling in legs (edema)

• Looking for signs of retinopathy in the eyes

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c) Blood and Urine Tests

These help identify secondary causes of hypertension or signs of organ damage.

• Blood Tests:

  • Kidney function (creatinine, BUN)

  • Blood sugar (glucose or A1C)

  • Electrolytes (potassium, sodium)

  • Cholesterol and triglycerides

• Urine Tests:

  • Protein or albumin (a sign of kidney damage)

  • Sugar (to screen for diabetes)

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d) Electrocardiogram (ECG or EKG)

An ECG records your heart’s electrical activity. It helps detect:

• Left ventricular hypertrophy (enlarged heart muscle)

• Arrhythmias (abnormal heart rhythm)

• Past or silent heart attacks

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e) Imaging Tests (if needed)

Depending on symptoms or risk, your doctor may order:

• Echocardiogram – an ultrasound to check heart function and size

• Renal ultrasound – to assess kidney size and blood flow

• Chest X-ray – to detect heart enlargement

• CT or MRI scans – in cases of suspected secondary hypertension or stroke risk

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Key Takeaways:

• Hypertension diagnosis is not based on one reading—it’s confirmed through repeated measurements and additional testing.

• Home monitoring, lab tests, and heart exams provide a comprehensive picture of your cardiovascular health.

• The earlier hypertension is detected, the easier it is to manage and prevent complications.

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Next Chapter Preview:

In Chapter 6, we’ll explore how to use home blood pressure monitors, track readings effectively, and build a personalized monitoring plan to stay in control of your numbers.

Let’s move from diagnosis to daily awareness and empowerment. 🩺📊💡

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