Laboratory Tests and Ancillaries
Hypertensive Crisis_Diagnostics 1It must be noted that diagnostic testing is not routinely required for hypertensive crisis, however, targeted studies should be guided by the history and physical exam when HMOD is suspected. A complete blood count (CBC) with platelet count, fibrinogen, haptoglobin, lactate dehydrogenase (LDH) can be done. Electrolytes, creatinine, estimated glomerular filtration rate (GFR), urine albumin to creatinine ratio, and urinalysis with microscopic exam of sediment may also be requested to check for renal dysfunction. Request for cardiac enzymes (eg troponin, CK-MB, NT-proBNP) if cardiac involvement is suspected. Blood smear may be done to detect microangiopathic hemolytic anemia. A pregnancy test and urine drug screen may also be done.
Hypertensive Crisis_Diagnostics 2A 12-lead electrocardiogram (ECG) may also be done to assess for ACS and arrhythmias.
Imaging
Request chest X-rays in patients suspicious for heart failure or pulmonary disease. Head computed tomography (CT) and/or MRI scan may be requested in patients presenting with neurological changes. Chest CT or MRI, transesophageal echocardiogram, or CT angiography of the thorax and/or abdomen may be done in patients suspected of aortic dissection. Request for echocardiography to assess LV function and evidence of ventricular hypertrophy. Renal ultrasound may also be done for suspected renal artery stenosis or renal impairment.