Last reviewed: April 2018
Last updated: April  2018

Summary

Definition

History and exam

Key diagnostic factors

  • BP >180/120 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
  • chronic kidney disease (CKD)
  • renal artery stenosis
  • renal transplant
  • endocrine disorders with known hypertensive effects
  • pregnancy
  • older age
  • black ethnicity
  • male sex
  • use of sympathomimetic drugs
  • pharmacotherapy with known hypertensive effect
  • obstructive sleep apnoea
  • vasculitis and connective tissue diseases

Diagnostic investigations

1st investigations to order

  • blood chemistry
  • FBC with smear
  • urinalysis with microscopy
  • electrocardiogram (ECG)
  • CXR
Full details

Investigations to consider

  • thyroid function tests
  • cardiac enzymes
  • brain natriuretic peptide (BNP)
  • urine toxicology screen
  • thoracic CT scan with contrast
  • transoesophageal echocardiography
  • renal ultrasound with Doppler
  • head CT without contrast
  • head MRI
  • plasma renin activity and aldosterone level
  • spot urine or plasma metadrenaline (metanephrine)
  • 24-hour urine free cortisol
  • sleep study
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Clinical Assistant Professor

Division of Nephrology

University of Iowa

Iowa City

IA

Disclosures

MLS declares that he has no competing interests.

Clinical Professor

Division of Nephrology

University of Iowa

Iowa City

IA

Disclosures

MS declares that he has no competing interests.

Dr M. Lee Sanders and Dr Manish Suneja would like to gratefully acknowledge Dr Hector Ventura and Dr Madhavi T. Reddy, previous contributors to this monograph. HV declares that he has no competing interests and MTR 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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