Most patients with hypertension can be successfully managed by the primary care provider. However, some patients may need to be referred to a hypertension specialist.
The most common reason for referral is a failure to adequately control hypertension with 3 drugs given in appropriate doses for a sufficient period of time. Some of these referrals may be averted by a careful lifestyle review, history and physical examination.
Additional reasons to consider referring a hypertensive patient to a specialist:
(1) severe or unacceptable adverse effects from drug therapy
(2) multiple hypertensive emergencies
(3) problematic comorbid conditions that be contributing to the hypertension and making management difficult
(4) uncertainty about the diagnosis
(5) severe, unexpected hypertension in pediatric patient or young adult
(6) need to perform specialized testing
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Purpose: To determine if a hypertensive patient should be referred to a hypertension specialist.
Objective: failure handling, when to refer, selection, response to therapy