Last reviewed: 25 Dec 2020
Last updated: 20 Nov 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • blood pressure ≥140/90 mmHg
  • retinopathy

Other diagnostic factors

  • headache
  • visual changes
  • dyspnoea
  • chest pain
  • sensory or motor deficit

Risk factors

  • obesity
  • sodium intake >1.5 g/day
  • aerobic exercise <3 times/week
  • low fruit and vegetable intake
  • moderate/high alcohol intake
  • metabolic syndrome
  • diabetes mellitus
  • black ancestry
  • age >60 years
  • family history of hypertension or coronary artery disease
  • dyslipidaemia
  • sleep apnoea

Diagnostic investigations

1st investigations to order

  • ECG
  • fasting metabolic panel with estimated GFR
  • lipid panel
  • urinalysis
  • Hb
  • thyroid-stimulating hormone
More 1st investigations to order

Investigations to consider

  • plasma renin activity
  • plasma aldosterone
  • renal duplex ultrasound/MRA renal arteries/CT angiography
  • 24-hour urine phaeochromocytoma screen
  • plasma fractionated metanephrines
  • 24-hour urine free cortisol
  • sleep study
  • echocardiography
More investigations to consider

Treatment algorithm


Internal Medicine

Regional Hypertension Co-Lead

Kaiser Permanente

Los Angeles



JB declares that he has no competing interests.

Dr Jeffrey Brettler would like to gratefully acknowledge Dr Joel Handler, Dr Jonathan N. Bella, Dr Moustapha Atoui, Dr Liran Blum, and Dr Michael A. Spinelli, previous contributors to this topic.


JH, JNB, MA, LB, and MAS declare that they have no competing interests.

Peer reviewersVIEW ALL

Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician

University of Dundee




IM is an elected member of the British Hypertension Society Executive Committee.

Associate Professor

Department of Cardiology

University of Texas MD Anderson Cancer Center




SWY declares that he has no competing interests.

Director Barts Blood Pressure Centre of Excellence

NHS Reader in Cardiovascular Medicine

Department of Clinical Pharmacology

William Harvey Heart Centre




ML is a consultant for ROX Medical. ML receives honorarium from Cardiosonic, St. Jude Medical, and institutional grant/research support from Medtronic.

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