Senior Medical investigator, Veterans Administration Hospital,

The diagnostic workup in hypertension seeks to identify the few curable forms of the disorder, to indicate those pa-tients who are at increased risk of com-plications, and to reveal those compli-cations that may already have oc-curred. Treatment is based on mod-erate sodium restriction and step-care therapy with antihypertensive agents. The cornerstone of drug therapy is a thiazide diuretic. Other agents, such as methyldopa, are added as required to achieve adequate control of blood pres-sure with a minimum of patient incon-venience. Compliance with therapy is vital, and the establishment of a thera-peutic partnership between physician and patient increases the chance of suc-cessful long-term treatment. INTRODUCYON The emphasis on the diagnostic work-up of the newly diagnosed hypertensive patient has changed in recent years. In the past, the workup was extensive and costly, with the purpose of determining whether the patient had a curable form of hypertension, such as pheochro-mocytoma or primary aldosteronism. However, the number of surgical pro-cedures performed even at such a re-ferral center as the Mayo Clinic ’ makes it clear that these curable forms of hy-pertension are extremely rare, ac-counting for perhaps only 1 % of the hy-pertension seen in patients over 40. In younger patients these forms are seen more often, but they are still quite un-usual. Today, an elaborate investiga-tion is justified only in the patient who has suggestive clinical evidence of a curable form 01 hypertension and who is under 40. It is important to realize that surgical treatment, especially in patients over 40, is not particularly suc-cessful. In renovascular hypertension, the most common kind of curable hy-pertension, surgery is generally re-served for patients under age 45, espe-cially those who do not respond to med-ical therapy. Only medical treatment is ordinarily used in patients over 50