11
Figure 3. Screening for Secondary Hypertension
Colors correspond to Class of
Recommendation on page 56–57.
New-onset or uncontrolled hypertension in adults
Screen for secondary
hypertension
(Class I)
(See Table 9)
YES NO
Screening not
indicated
(No Benefit)
Refer to clinician with
specific expertise
(Class llb)
Recommendations for Secondary Forms of Hypertension
COR LOE
Recommendations
I C-EO Screening for specific form(s) of secondary hypertension is
recommended when the clinical indications and physical
examination findings listed in Table 9 are present or in adults
with resistant hypertension.
IIb C-EO If an adult with sustained hypertension screens positive for a form
of secondary hypertension, referral to a physician with expertise
in that form of hypertension may be reasonable for diagnostic
confirmation and treatment.
Conditions
• Drug-resistant/induced hypertension
• Abrupt onset of hypertension
• Onset of hypertension at <30 y
• Exacerbation of previously controlled hypertension
• Disproportionate target organ damage for degree of hypertension
• Accelerated/malignant hypertension
• Onset of diastolic hypertension in older adults (age ≥65 y)
• Unprovoked or excessive hypokalemia
Positive
screening
test
Referral not
necessary
(No Benefit)
