Testing in hypertensive patients

[VA Hopeful Dr]

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So yesterday I started up the HTN Metric (my next cycle starts in 2017 and this takes 3 months to finish apparently...) and it asks if I've done urine microalbumin screening at least every 2 years on patients with HTN, an ECG screening, or echo, for LVH.

I have never heard of doing any of that routinely and was wondering if anyone else had either?

 

[smq123]

We used to be asked to do all this in residency.

I do microalbumin testing routinely, but I spent the last 4 years seeing a mostly African American population, which had a surprising amount of occult kidney disease. So I was hypervigilant about their kidneys.

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[Bacchus]

I still think UA/EKG/?Microalbumin are recommended on HTN dx. If abnormal EKG then ECHO. Kidney disease horrifies me so I check microalbumins yearly.

http://www.ccjm.org/index.php?id=10...360985&cHash=919478ef7efea78a22453e2bc0f28fbe

 

[deleted87716]

Annual urine microalbumin/creatinine ratios in HTN are a quality measure, so I've been doing them for years. I do an EKG and CXR as part of the initial workup. Subsequently, I'll check EKGs every 2-3 years, maybe annually if the patient is on a non-dihydropyridine CCB or beta blocker. I'll check a CXR every 3-5 years. However, the evidence for doing so routinely (e.g., to monitor for LVH) is rather slim, AFAIK. I don't order routine echocardiograms for HTN.

 

[VA Hopeful Dr]

Huh, and people say that they never learn anything from the Part IV stuff. Interestingly, apparently the recommendation for LVH screening is "expert consensus" level, but since everyone else is doing it I'd best get with the times.

Thanks all!