Last reviewed: August 2018
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • BP ≥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
  • fasting lipid panel
  • urinalysis
  • Hb
  • TSH
Full details

Investigations to consider

  • plasma renin activity (PRA)
  • 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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Internal Medicine and Assistant Area Medical Director

Kaiser Permanente

Los Angeles

CA

Disclosures

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 reviewers VIEW ALL

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.

Associate Professor

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

Tx

Disclosures

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

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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