What diagnostic evaluation is useful to rule out end-organ damage in hypertensive patients?

In the context of evaluating hypertensive patients for end-organ damage, the measurement of thyroid-stimulating hormone (TSH) levels is significant. While numerous tests can assess various aspects of health in hypertensive patients, normal TSH levels specifically indicate that there is no thyroid dysfunction contributing to hypertension. Thyroid disorders, particularly hyperthyroidism, can lead to secondary hypertension and other cardiovascular issues, potentially causing end-organ damage such as cardiomyopathy or increased cardiac workload.

Establishing normal TSH levels helps clinicians rule out such metabolic causes that could lead to secondary hypertension. When the thyroid is functioning normally, it indicates that one potential source of end-organ damage, related to hormonal imbalances, is not present.

The other options—CT angiography, chest X-ray, and cardiac catheterization—are more invasive or directed toward looking for structural or immediate pathological changes rather than assessing the systemic influence of thyroid hormones on hypertension. Therefore, gaining insight into the thyroid's function is a crucial first step in evaluating and ruling out causes of end-organ damage in hypertensive patients.