Which studies should be performed to identify secondary causes of hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Other studies may be obtained on the basis of clinical findings or in individuals with suspected secondary hypertension and/or evidence of target-organ disease, such as complete blood count (CBC), chest radiograph, uric acid, and urine microalbumin. [5] Table 2, below, summarizes the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) screening tests for specific identifiable causes of hypertension.

Table 2. Identifiable Hypertension and Screening Tests (Open Table in a new window)

Condition

Screening Test

Chronic kidney disease

Estimated glomerular filtration rate

Coarctation of the aorta

Computed tomography angiography

Cushing syndrome; other states of glucocorticoid excess (eg, chronic steroid therapy

Dexamethasone suppression test

Drug-induced/drug-related hypertension*

Drug screening

Pheochromocytoma

24-hour urinary metanephrine and normetanephrine

Primary aldosteronism, other states of mineralocorticoid excess

Plasma aldosterone to renin activity ratio (ARR). If abnormal, refer for further evaluation such as saline infusion to determine if aldosterone levels can be suppressed, 24-hour urinary aldosterone level, and specific mineralocorticoid tests

Renovascular hypertension

Doppler flow ultrasonography, magnetic resonance angiography, computed tomography angiography

Sleep apnea

Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness Scale [ESS])

Thyroid/parathyroid disease

Thyroid stimulating hormone level, serum parathyroid hormone level

Adapted from:  Chobanian AV, Bakris GL, Black HR, et al, and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. Dec 2003;42(6):1206-52. [5]

* Some examples of agents that induce hypertension include nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors; illicit drugs; sympathomimetic agents; oral contraceptive or adrenal steroid hormones; cyclosporine and tacrolimus; licorice; erythropoietin; and certain over-the-counter dietary supplements and medicines, such as ephedra, ma huang, and bitter orange. Drug-related causes of hypertension may be due to nonadherence, inadequate doses, and inappropriate combinations.


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