Module 9: Monitoring & Follow-Up
BP monitoring methods, follow-up visit schedules, baseline laboratory evaluation, and drug-specific monitoring requirements.
Recommended BP Monitoring Method
Home BP Monitoring (HBPM)
Morning and evening readings for ≥3 days (preferably 7 days) before each clinic visit; 2 readings per session, 1 minute apart
Home blood pressure monitoring (HBPM) is recommended for confirmation and ongoing management of hypertension
Follow-up Visit Schedule
Monthly follow-up until BP is at goal; check labs 2–4 weeks after medication changes
Source: 2025 AHA/ACC HTN Guideline, Section 6.
Baseline Laboratory Evaluation
| Test | Timing | Rationale |
|---|---|---|
| Basic metabolic panel (BMP): Na+, K+, Cl−, CO2, BUN, creatinine, glucose | At diagnosis, and 2–4 weeks after starting or changing diuretics, ACEi, ARB, or MRA | Establishes baseline renal function and electrolytes; guides drug selection and detects adverse effects |
| eGFR | At diagnosis, then annually | CKD (eGFR <60) affects drug selection and BP targets; eGFR dip ≤30% after RAASi initiation is expected |
| Fasting lipid panel | At diagnosis, then per lipid guideline | ASCVD risk assessment — hyperlipidemia commonly co-occurs with hypertension |
| Urinalysis with urine albumin-to-creatinine ratio (UACR) | At diagnosis, then annually in patients with DM or CKD | Detects subclinical kidney disease and guides BP target selection |
| Thyroid-stimulating hormone (TSH) | At diagnosis if thyroid disease suspected | Hypothyroidism and hyperthyroidism are secondary causes of hypertension |
| Fasting glucose or HbA1c | At diagnosis, then annually | Diabetes is a major cardiovascular risk factor; thiazides can worsen glycemia |
| Electrocardiogram (ECG) | At diagnosis | Detect left ventricular hypertrophy, arrhythmias, or prior MI |
Source: 2025 AHA/ACC HTN Guideline, Sections 5.2.7 and 6.
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