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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Related Studies

Ontology: Hypertensive disease (C0020538)

Definition (MEDLINEPLUS)

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

  • 119/79 or lower is normal blood pressure
  • 140/90 or higher is high blood pressure
  • Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

NIH: National Heart, Lung, and Blood Institute
Definition (NCI_CDISC) Pathological increase in blood pressure defined as one of the following: History of hypertension diagnosed and treated with medication, diet, and/or exercise; On at least 2 separate occasions, documented blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg diastolic in patients without diabetes or chronic kidney disease, or blood pressure greater than 130 mm Hg systolic or 80 mm Hg diastolic in patients with diabetes or chronic kidney disease; Currently on pharmacological therapy for the treatment of hypertension.
Definition (NCI) Blood pressure that is abnormally high.
Definition (NCI_CTCAE) A disorder characterized by a pathological increase in blood pressure; a repeatedly elevation in the blood pressure exceeding 140 over 90 mm Hg.
Definition (NCI_NCI-GLOSS) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness.
Definition (CSP) persistantly high arterial blood pressure.
Definition (MSH) Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Concepts Disease or Syndrome (T047)
MSH D006973
ICD9 997.91, 401-405.99
ICD10 I10-I15.9 , I10, I10-I15
SnomedCT 38341003, 155302005, 194757006, 194760004, 155295004, 194756002, 266287006, 194794002, 195537001
LNC MTHU020789, LA14293-7, LA7444-8
English Hypertension, BLOOD PRESSURE HIGH, HYPERTENSION ARTERIAL, Hypertensive disease NOS, Hypertensive diseases, [X]Hypertensive diseases, Systemic hypertension, Hypertensive disorder, systemic arterial, hyperpiesia, hyperpiesis, systemic HTN, systemic hypertension (diagnosis), systemic hypertension, Hypertension arterial, Blood pressure high, HBP, HT, Hypertension NOS, Surg comp - hypertension, HTN, Hypertension [Disease/Finding], high blood pressure, hypertensive disorder, hypertensive vascular disease, arterial hypertension, arterial hypertension systemic, vascular hypertension, blood high pressure, high blood pressure disorder, systemic arterial hypertension, hypertensive disease, Hypertensive diseases (I10-I15), Complications affecting other specified body systems, not elsewhere classified, hypertension, High Blood Pressure, Hypertensive disease NOS (disorder), Hypertensive disease (disorder), (Hypertensive disease) or (hypertension), (Hypertensive disease) or (hypertension) (disorder), [X]Hypertensive diseases (disorder), hypertension, BLOOD PRESSURE, INCREASED, BLOOD PRESSURE, HIGH, Hypertensive Disorder, HIGH BLOOD PRESSURE, INCREASED BLOOD PRESSURE, HYPERTENSION, PRESSURE, HIGH BLOOD, High blood pressure, Hyperpiesia, Hyperpiesis, Hypertensive vascular degeneration, Hypertensive vascular disease, BP - High blood pressure, High blood pressure disorder, Systemic arterial hypertension, HBP - High blood pressure, BP+ - Hypertension, HT - Hypertension, Hypertensive disorder, systemic arterial (disorder), Hypertensive disorder, HTN - Hypertension, blood pressure; high, high; arterial tension, high; blood pressure, Hypertension, NOS, Hypertensive disease, NOS, Raised blood pressure (disorder), Blood Pressure, High, Blood Pressures, High, High Blood Pressures, Vascular Hypertensive Disorder, Hypertensive disease, HYPERTENSIVE DISEASE
French HYPERTENSION ARTERIELLE, Pression artérielle élevée, PAH, Hypertension SAI, TH, HYPERTENSION, TENSION ARTERIELLE E, Hypertension chronique, Hypertension permanente, Hypertension artérielle, Hypertension
Portuguese HIPERTENSAO, Hipertensão arterial NE, Hipertensão arterial, Pressão arterial alta, HYPERTENSAO ARTERIAL, PRESSAO SANGUINEA ELEVADA, Pressão Arterial Alta, Pressão Sanguínea Alta, Hipertensão
Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, HIPERTENSION ARTERIAL, enfermedad hipertensiva, SAI, [X]enfermedades hipertensivas (trastorno), enfermedad hipertensiva, SAI (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertensión, Presión Sanguínea Alta
German HYPERTONIE, Hypertonie, arteriell, Blutdruck, hoch, HBP, HT, Hypertonie NNB, BLUTDRUCK HOCH, HYPERTONIE ARTERIELL, Hypertension, Hypertonie
Dutch hypertensie NAO, hoge bloeddruk, arteriële hypertensie, bloeddruk; hoog, hoog; arteriële druk, hoog; bloeddruk, hypertensie, Bloeddruk, hoge, Hypertensie
Italian Ipertensione (HT), Ipertensione NAS, Pressione del sangue elevata, Ipertensione, Pressione sanguigna alta, Ipertensione arteriosa
Japanese 動脈性高血圧, 高血圧ＮＯＳ, ｺｳｹﾂｱﾂ, ｺｳｹﾂｱﾂNOS, ﾄﾞｳﾐｬｸｾｲｺｳｹﾂｱﾂ, 高血圧, 高血圧症
Swedish Högt blodtryck
Czech hypertenze, Arteriální hypertenze, Vysoký krevní tlak, Hypertenze NOS, Hypertenze, vysoký krevní tlak, hypertonie
Finnish Kohonnut verenpaine
Russian GIPERTENZIIA, GIPERTONICHESKAIA BOLEZN', KROVIANOE DAVLENIE VYSOKOE, ГИПЕРТЕНЗИЯ, ГИПЕРТОНИЧЕСКАЯ БОЛЕЗНЬ, КРОВЯНОЕ ДАВЛЕНИЕ ВЫСОКОЕ
Croatian HIPERTENZIJA
Polish Nadciśnienie
Hungarian Arteriás hypertonia, Hypertensio, HT, RR magas, Hypertonia k.m.n., Magas vérnyomás
Norwegian Høyt blodtrykk, Hypertensjon, Hypertoni
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Secondary hypertension (C0155616)

Concepts Disease or Syndrome (T047)
ICD9 405, 405.9
ICD10 I15 , I15.9
SnomedCT 155300002, 194789002, 194792003, 31992008
English Unspecified secondary hypertension, Secondary hypertension NOS, Secondary hypertension, unspecified, unspecified secondary hypertension (diagnosis), secondary hypertension (diagnosis), secondary hypertension, unspecified secondary hypertension, Hypertension secondary, hypertension secondary, Secondary hypertension NOS (disorder), Secondary hypertension, Secondary hypertension (disorder), hypertension; secondary, secondary; hypertension, Secondary hypertension, NOS, Secondary Hypertension, Hypertension;secondary
Italian Ipertensione secondaria, Ipertensione secondaria NAS, Ipertensione secondaria non specificata
Dutch hypertensie secundair, niet-gespecificeerde secundaire hypertensie, secundaire hypertensie, niet-gespecificeerd, secundaire hypertensie NAO, hypertensie; secundair, secundair; hypertensie, Secundaire hypertensie, niet gespecificeerd, secundaire hypertensie, Secundaire hypertensie
French Hypertension secondaire, non précisée, Hypertension secondaire SAI, Hypertension secondaire non précisée, Hypertension secondaire
German sekundaere Hypertonie, unspezifisch, sekundaere Hypertonie NNB, Hypertonie sekundaer, unspezifische sekundaere Hypertonie, Sekundaere Hypertonie, nicht naeher bezeichnet, Sekundaere Hypertonie, sekundaere Hypertonie
Portuguese Hipertensão secundária NE, Hipertensão arterial secundária NE, Hipertensão secundária
Spanish Hipertensión secundaria no especificada, Hipertensión secundaria NEOM, Secondary hypertension NOS, hipertensión secundaria, SAI, hipertensión secundaria, SAI (trastorno), hipertensión arterial secundaria (trastorno), hipertensión arterial secundaria, Hipertensión secundaria
Japanese 二次性高血圧、詳細不明, 二次性高血圧, 二次性高血圧ＮＯＳ, ﾆｼﾞｾｲｺｳｹﾂｱﾂｼｮｳｻｲﾌﾒｲ, ﾆｼﾞｾｲｺｳｹﾂｱﾂ, ﾆｼﾞｾｲｺｳｹﾂｱﾂNOS
Czech Blíže neurčená sekundární hypertenze, Hypertenze sekundární, Sekundární hypertenze, blíže neurčená, Sekundární hypertenze, Sekundární hypertenze NOS
Korean 이차 고혈압, 상세불명의 이차 고혈압
Hungarian Másodlagos hypertonia, Secundaer hypertonia, Másodlagos hypertonia k.m.n., Másodlagos hypertonia, nem meghatározott, Meghatározatlan másodlagos hypertonia
Derived from the NIH UMLS (Unified Medical Language System)

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