19
Patient Evaluation
Table 11. Historical Features Favoring Hypertension Cause
Primary Hypertension Secondary Hypertension
• Gradual increase in BP, with slow
rate of rise in BP
• Lifestyle factors that favor higher
BP (e.g., weight gain, high-sodium
diet, decreased physical activity,
job change entailing increased
travel, excessive consumption of
alcohol)
• Family history of hypertension
• BP lability, episodic pallor and dizziness
(pheochromocytoma)
• Snoring, hypersomnolence (obstructive sleep
apnea)
• Prostatism (chronic kidney disease due to
post-renal urinary tract obstruction)
• Muscle cramps, weakness (hypokalemia
from primary aldosteronism or secondary
aldosteronism due to renovascular disease)
• Weight loss, palpitations, heat intolerance
(hyperthyroidism)
• Edema, fatigue, frequent urination (kidney
disease or failure)
• History of coarctation repair (residual
hypertension associated with coarctation)
• Central obesity, facial rounding, easy
bruisability (Cushing's syndrome)
• Medication or substance use (e.g., alcohol,
NSAIDs, cocaine, amphetamines)
• Absence of family history of hypertension
Table 12. Basic and Optional Laboratory Tests for Primary
Hypertension
Basic testing
Fasting blood glucose
a
Complete blood count
Lipid profile
Serum creatinine with eGFR
a
Serum sodium, potassium, calcium
a
yroid-stimulating hormone
Urinalysis
Electrocardiogram
Optional testing Echocardiogram
Uric acid
Urinary albumin to creatinine ratio
a
May be included in a comprehensive metabolic panel.
