Evaluation of End Organ Damage in Hypertensive Patients
No evidence to date supports the ED workup for end-organ damage in asymptomatic hypertensive patients.
End-Organ Damage Pearls:
Rarely, if ever, will an aimless search for lab abnormalities lead to any clinically meaningful change in patient management
An elevated creatinine does NOT define acute, end-organ damage. Most of the time it is due to the effects of chronic hypertension.
There is some evidence that a UA that has BOTH no protein and no red cells predicts a normal creatinine. The studies that have looked at this, however, are very small. Also, HTN in and of itself may cause some protein leak, even in the setting of normal renal function
A CXR and/or ECG is not needed in an asymptomatic patient.
Prompt followup is always necessary especially if no ED workup is started. All of this can be dome in the primary care doctor's office.
