Last reviewed: October 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • BP above 210/130 mmHg
  • presence of risk factors

Other diagnostic factors

  • neurological symptoms
  • cardiac symptoms
  • abnormal cardiopulmonary examination
  • oliguria or polyuria
  • abnormal fundoscopic examination
  • abnormal neurological examination

Risk factors

  • inadequately treated hypertension
  • older age
  • black ethnicity
  • male gender
  • use of sympathomimetic drugs
  • use of monoamine oxidase inhibitors (MAOIs)

Diagnostic investigations

1st investigations to order

  • FBC with smear
  • blood chemistry
  • urinalysis with microscopy
  • electrocardiogram
  • CXR
  • head CT without contrast
  • head MRI
  • spot urine or plasma metanephrine
Full details

Investigations to consider

  • thoracic CT scan with contrast
  • transoesophageal echocardiography (TEE)
  • plasma renin activity and aldosterone level
  • single-dose captopril challenge
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Hector Ventura

Head

Section of Cardiomyopathy and Heart Transplantation

Ochsner Clinic Foundation

New Orleans

LA

Disclosures

HV declares that he has no competing interests.

Assistant Professor

University of Pennsylvania

Philadelphia

PA

Disclosures

MR is employed by Merck and owns stocks in Merck, and Johnson & Johnson.

Peer reviewers VIEW ALL

Physician Consultant

Preventive Medicine

Private Practice

Atlanta

GA

Disclosures

AS declares that she has no competing interests.

Assistant Professor

Department of Internal Medicine

University of Colorado Health Sciences Center

Denver

CO

Disclosures

EC declares that he has no competing interests.

Department of Clinical Pharmacology

St Mary’s Hospital

Imperial College

London

UK

Disclosures

MS declares that he has no competing interests.

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