Hypertension Evaluation

Aka: Hypertension Evaluation, Secondary Hypertension

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II. Epidemiology

  1. Secondary Hypertension accounts for 5-10% of Hypertension Causes overall
    1. In age 18 to 40 years old, accounts for 30% of Hypertension

III. Approach

  1. See Hypertension
  2. Confirm Hypertension
    1. See Hypertension Criteria
    2. Confirm with at least 2-3 reliable Blood Pressure readings over at least 2 separate visits
      1. Repeated manual Blood Pressure readings in both arms with properly sized cuff
    3. Confirm with Ambulatory Blood Pressure Monitoring or Home Blood Pressure Monitoring
      1. Recommended by USPTF before starting medications for Asymptomatic Hypertension
  3. Identify associated Hypertension risk factors
    1. See Hypertension history
    2. See Medication Causes of Hypertension
    3. Obesity
    4. Alcohol Abuse
    5. Sedentary lifestyle
    6. Tobacco Abuse
    7. Excessive emotional Stress
    8. Obstructive Sleep Apnea
    9. Poor diet (high Sodium, low Potassium)
  4. Identify target organ disease
    1. Coronary Artery Disease
    2. Peripheral Vascular Disease
    3. Congestive Heart Failure
    4. Cerebrovascular Disease (CVA, TIA)
    5. Chronic Kidney Disease
    6. Alzheimer's Disease
  5. Consider Secondary Hypertension
    1. See Secondary Hypertension Causes
    2. Indications for secondary Hypertension Evaluation
      1. Hypertension Onset under age 30 years (and esp. under age 12) or over age 60 years old
      2. Accelerated Hypertension or Malignant Hypertension
      3. Signs OR symptoms of Secondary Hypertension
      4. Refractory Hypertension to maximal medical management (especially if previously controlled)
        1. Especially if previously controlled
        2. Especially if Severe Hypertension (SBP >180 mmHg, DBP >120 mmHg)

IV. Causes: Secondary Hypertension

  1. See Secondary Hypertension Causes

V. Evaluation

  1. See Hypertension Evaluation History
  2. See Hypertension Evaluation Exam
  3. See Hypertension Evaluation Labs
  4. ACC Cardiovascular Risk Calculator (ASCVD Risk Estimator)
    1. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
  5. Monitoring
    1. Mild Blood Pressure Increase
      1. Recheck in 1-2 months
    2. Moderate Blood Pressure Increase
      1. Recheck in 1-2 weeks
    3. Severe or accelerated Malignant Hypertension
      1. See Hypertensive Urgency
      2. Immediate Treatment
    4. End Organ Damage
      1. See Hypertensive Emergency
      2. Immediate Treatment

VI. Management

  1. See Hypertension Management
  2. See Resistant Hypertension
  3. See Hypertensive Crisis
  4. See Severe Asymptomatic Hypertension

VII. References

  1. Charles (2017) Am Fam Physician 96(7): 453-61 [PubMed]

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