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Other investigations

Once the diagnosis of hypertension has been made, further testing may be performed to find secondary hypertension, identify comorbidities such as diabetes, identify hypertension-caused organ damage such as chronic kidney disease or thickening of the heart muscle, and for cardiovascular disease risk stratification.

Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and adults and has multiple risk factors, including obesity and a family history of hypertension.

Initial assessment upon diagnosis of hypertension should include a complete history and physical examination. The World Health Organization suggests the following initial tests: serum electrolytes, serum creatinine, lipid panel, HbA1c or fasting glucose, urine dipstick and electrocardiogram (ECG/EKG). Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain anti-hypertensive drugs on kidney function. Testing of urine samples for protein is used as a secondary indicator of kidney disease. Lipid panel and glucose tests are done to identify comorbidities such as diabetes and hyperlipidemia and for cardiovascular risk stratification. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure, such as thickening of the heart muscle or whether the heart has experienced a prior minor disturbance such as a silent heart attack.