1) Proper Element — Patients with greater than 10 years of poorly controlled hypertension may be more likely to have end organ damage.
2) Proper Element — Congestive heart failure is considered end organ damage of hypertension.
3) Proper Element — Peripheral vascular disease is considered end organ damage of hypertension.
4) Not a Proper Element — Does the patient have cancer history? Although this may be part of a routine patient history it does not play a role in a focused history of a patient with hypertension.
5) Proper Element — Patients with diabetes may also have hypertension as part of metabolic syndrome.
6) Proper Element — Cardiovascular disease is part of the end organ damage of hypertension.
7) Proper Element — Renal disease is part of the end organ damage of hypertension.
8) Proper Element — Patients with cholesterol issues may also have hypertension as part of metabolic syndrome.
9) Not a Proper Element — Does the patient have glaucoma disease? Although this may be part of a routine patient history it does not play a role in a focused history of a patient with hypertension. Glaucoma is not directly associated with essential hypertension, however retinopathy may be considered target end organ damage from hypertension.
10) Proper Element — A patient with a family history of premature cardiovascular disease or death (men under age 55 or women under age 65) can mean the patient has eight times a higher risk of cardiovascular disease or death than the rest of the population.
11) Proper Element — A family history of diabetes may mean a higher risk of diabetes for a patient with hypertension.
12) Proper Element — A family history of high cholesterol may mean a higher risk of hyperlipidemia for a patient with hypertension.
13) Not a Proper Element — Does the patient have a family history of colon cancer? Although this may be part of a routine patient history it does not play a role in a focused history of a patient with hypertension.
14) Proper Element — A review of all medications including over the counter and complementary medications is crucial. Some common prescription medications like birth control pills, amphetamines, thyroid medications, steroids, and certain anti-depressants may elevate blood pressure. Some common over the counter medications can also elevate blood pressure such as pseudoephedrine, appetite suppressants, or NSAIDS. Some herbal remedies may also elevate blood pressure such as ma huang, bitter orange, Ginkgo, Ginseng, licorice, and St. John’s wort.
15) Proper Element — Weight changes especially weight gain are important.
16) Proper Element — Tobacco smoking elevates blood pressure, contributes to increased morbidity and mortality, and interferes with the efficacy of blood pressure medications.
17) Proper Element — Alcohol and drug history are important. Alcohol intake should be limited to no more than 1 oz (30 mL) of ethanol, the equivalent of two drinks per day in most men and no more than 0.5 oz of ethanol (one drink) per day in women and lighter weight persons. Cocaine and ketamine use and narcotic withdrawl can elevate blood pressure.
18) Proper Element — Assessing the diet history is important in order to counsel the patient appropriately.
19) Proper Element — Review of psychosocial stressors is also crucial. Stress directly causes the release of angiotensin II and norepinephrine in the body (flight or fight syndrome) and it also makes prioritizing adherence to blood pressure medicines difficult.