18
Evaluation and Diagnosis
YES
YES
1
Screen for primary
aldosteronism and other
secondary forms of HTN
Positive screening test?
• Drug-resistant/induced HTN
• Abrupt onset of HTN
• Onset of HTN at <30 y
• Exacerbation of previously controlled HTN
• Disproportionate TOD for degree of HTN
• Accelerated/malignant HTN
• Onset of diastolic HTN in older adults
(age ≥65 y)
• Unprovoked or excessive
hypokalemia
• Insomnia or daytime sleepiness
• Concomitant adrenal nodule
• History of early-onset stroke
• Family history of primary
aldosteronism
Does the patient have any of the following conditions associated with
secondary HTN?
2b
Refer to clinician with
specific secondary HTN
expertise
Figure 5. Screening for Features Suggesting Secondary
Hypertension
Refer to Table 10 for additional tests for secondary hypertension.
HTN indicates hypertension; and TOD, target organ damage (eg, cerebrovascular disease,
hypertensive retinopathy, left ventricular hypertrophy, left ventricular dysfunction, HF, coronary
artery disease, CKD, albuminuria, PAD).
Modified with permission from Whelton et al. Copyright © 2018 American College of Cardiology
Foundation and American Heart Association, Inc.
