Hypertension Evaluation History

Aka: Hypertension Evaluation History

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II. History: Past Medical History

  1. Severity of Hypertension with Blood Pressure log
  2. Onset of Hypertension
    1. Age <12: Associated with Secondary Hypertension in >70% of cases
    2. Age 12-18: Associated with Secondary Hypertension in 10-15% of cases
    3. Age 19-39: Associated with Secondary Hypertension in 5% of cases
    4. Age 40-64: Associated with Secondary Hypertension in 8-12% of cases
    5. Age >65: Associated with Secondary Hypertension in 17% of cases
    6. Viera (2010) Am Fam Physician 82(12): 1471-8 [PubMed]

III. History: Family History

  1. Hypertension
  2. Kidney disease

IV. History: Medications

  1. See Medication Causes of Hypertension

V. History: Habits

  1. Salt intake
  2. Fat intake
  3. High Caloric Intake contributing to Obesity
  4. Alcohol use
  5. Tobacco Use
  6. Recreational Drugs of Abuse (stimulants)
    1. Cocaine
    2. Methamphetamine

VI. History: Lead Exposure Risk

  1. Lead paints
  2. Printer inks
  3. Inhalation risks
  4. Postmenopausal women
    1. Lead increases due to skeletal lead mobilization
    2. Nash (2003) JAMA 289:1523-32 [PubMed]

VII. History: Symptoms of Urinary tract Disease

  1. Urinary Tract Infection
  2. Nephrolithiasis (or Hypercalcemia)
  3. Benign Prostatic Hypertrophy

VIII. Findings: Evidence of Endocrine Disease

  1. Diabetes Mellitus
  2. Hyperthyroidism
  3. Hypothyroidism
  4. Hyperparathyroidism (Hypercalcemia)
    1. Confusion
    2. Major Depression
    3. Abdominal Pain
    4. Nephrolithiasis
    5. Constipation
  5. Cushing's Disease
    1. Acne Vulgaris
    2. Osteoporosis
    3. Bone Fractures
    4. Glucose Intolerance
  6. Aldosteronism
    1. Hypokalemia
    2. Muscle Weakness
    3. Paresthesias
    4. Tetany
  7. 11-Hydroxylase deficiency
    1. Premature Virilization in males
    2. Masculinization in females
  8. 17-Hydroxylase deficiency
    1. Failed sex maturation
  9. Pheochromocytoma
    1. Flushing
    2. Sweating
    3. Tremor
    4. Panic
    5. Facial pallor
    6. Headache
    7. Weight loss
    8. Labile Blood Pressure
    9. Orthostatic Hypotension
    10. Palpitations
    11. Syncope

IX. Findings: Evidence of Renal Disease

  1. Renal Artery Stenosis (renovascular disease)
    1. Serum Creatinine increases 50% or more over baseline after starting ACE Inhibitor or ARB
    2. Unilateral small Kidney on Ultrasound
    3. Recurrent flash Pulmonary Edema
  2. Renal Disease
    1. Serum Creatinine increased
    2. Proteinuria

X. Findings: Evidence of Neurologic Disease

  1. Previous Neurologic disease or symptoms
  2. Headaches
  3. Confusion
  4. Seizures

XI. Findings: Evidence of Cardiovascular disease

  1. Coronary Artery Disease
  2. Congestive Heart Failure
  3. Amaurosis Fugax
  4. Claudication
  5. Renal Artery Stenosis

XII. Findings: Evidence of Sleep Disorder

  1. Loud snoring
  2. Daytime Somnolence
  3. Witnessed apneas
  4. May be associated with Headache, Fatigue, difficult concentration

XIII. References

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

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