Htn

Hypertension Evaluation

search

Hypertension Evaluation, Secondary Hypertension

  • See Also
  1. Medication Causes of Hypertension
  2. Pregnancy Induced Hypertension
  3. Hypertension
  4. Hypertension Causes
  5. Hypertension Evaluation History
  6. Evaluation Exam
  7. Hypertension Evaluation Labs
  8. Isolated Systolic Hypertension
  9. Hypertension Management
  10. Hypertension Risk Stratification
  11. Resistant Hypertension
  12. Antihypertensive Selection
  13. Hypertension Management for Specific Comorbid Diseases
  14. Hypertension Management for Specific Populations
  15. Hypertension Management for Specific Emergencies
  16. Hypertension in Children
  17. Hypertension in Infants
  18. Hypertension in Pregnancy
  19. Hypertension in Athletes
  20. Hypertension in the Elderly
  • Epidemiology
  1. Secondary Hypertension accounts for 5-10% of Hypertension Causes overall
    1. In age 18 to 40 years old, accounts for 30% of Hypertension
  • Approach
  1. See Hypertension
  2. Confirm Hypertension
    1. See Hypertension Criteria
    2. Confirm with at least 2-3 reliable Blood Pressure readings over at least 2 separate visits
      1. Repeated manual Blood Pressure readings in both arms with properly sized cuff
    3. Confirm with Ambulatory Blood Pressure Monitoring or Home Blood Pressure Monitoring
      1. Recommended by USPTF before starting medications for Asymptomatic Hypertension
  3. Identify associated Hypertension risk factors
    1. See Hypertension history
    2. See Medication Causes of Hypertension
    3. Obesity
    4. Alcohol Abuse
    5. Sedentary lifestyle
    6. Tobacco Abuse
    7. Excessive emotional Stress
    8. Obstructive Sleep Apnea
    9. Poor diet (high Sodium, low Potassium)
  4. Identify target organ disease
    1. Coronary Artery Disease
    2. Peripheral Vascular Disease
    3. Congestive Heart Failure
    4. Cerebrovascular Disease (CVA, TIA)
    5. Chronic Kidney Disease
    6. Alzheimer's Disease
  5. Consider Secondary Hypertension
    1. See Secondary Hypertension Causes
    2. Indications for secondary Hypertension Evaluation
      1. Hypertension Onset under age 30 years (and esp. under age 12) or over age 60 years old
      2. Accelerated Hypertension or Malignant Hypertension
      3. Signs OR symptoms of Secondary Hypertension
      4. Refractory Hypertension to maximal medical management (especially if previously controlled)
        1. Especially if previously controlled
        2. Especially if Severe Hypertension (SBP >180 mmHg, DBP >120 mmHg)
  • Causes
  • Secondary Hypertension
  1. See Secondary Hypertension Causes
  • Evaluation
  1. See Hypertension Evaluation History
  2. See Hypertension Evaluation Exam
  3. See Hypertension Evaluation Labs
  4. ACC Cardiovascular Risk Calculator (ASCVD Risk Estimator)
    1. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
  5. Monitoring
    1. Mild Blood Pressure Increase
      1. Recheck in 1-2 months
    2. Moderate Blood Pressure Increase
      1. Recheck in 1-2 weeks
    3. Severe or accelerated Malignant Hypertension
      1. See Hypertensive Urgency
      2. Immediate Treatment
    4. End Organ Damage
      1. See Hypertensive Emergency
      2. Immediate Treatment
  • Management
  1. See Hypertension Management
  2. See Resistant Hypertension
  3. See Hypertensive Crisis
  4. See Severe Asymptomatic Hypertension
  • References
  1. Charles (2017) Am Fam Physician 96(7): 453-61 [PubMed]