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Last reviewed: 18 Jan 2025
Last updated: 08 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • systolic blood pressure (BP) ≥130 mmHg or diastolic BP ≥80 mmHg
  • retinopathy

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • urinary albumin-to-creatinine ratio (UACR)
  • ECG
  • fasting metabolic panel with estimated GFR
  • lipid panel
  • urinalysis
  • haemoglobin
  • thyroid-stimulating hormone

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

Treatment algorithm

Contributors

Authors

Jeffrey Brettler, MD, FASH

Internal Medicine

Regional Hypertension Co-lead, Kaiser Permanente Southern California, Los Angeles

Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena

CA

Disclosures

JB declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Isla Mackenzie, MBChB, PhD, FRCP

Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician

University of Dundee

Dundee

UK

Disclosures

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

Syed Wamique Yusuf, MRCPI, FACC

Associate Professor

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Melvin Lobo, MBChB, PhD, MRCP

Director Barts Blood Pressure Centre of Excellence

NHS Reader in Cardiovascular Medicine

Department of Clinical Pharmacology

William Harvey Heart Centre

London

UK

Disclosures

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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