20
Evaluation and Diagnosis
Table 10. Causes of Secondary Hypertension With Indications
for Additional Testing and Diagnostic Screening Tests
Prevalence Indications for Additional Testing
Common causes
OSA 25%–50% Snoring, choking, gasping during sleep; daytime
sleepiness; resistant hypertension
CKD 14% Diabetes, obstruction, hematuria; urinary
frequency and nocturia; urinary incontinence,
analgesic abuse; family history of polycystic
kidney disease; elevated serum creatinine;
abnormal urinalysis
Primary
aldosteronism
5%–25% Resistant hypertension; hypertension with
hypokalemia (spontaneous or diuretic
induced); hypertension and muscle cramps
or weakness; hypertension and incidentally
discovered adrenal mass; hypertension and
obstructive sleep apnea; hypertension and
family history of early-onset hypertension or
stroke
Drug or alcohol
induced
2%–20% Sodium-containing antacids; antidepressants;
nicotine (smoking ); alcohol; NSAIDs; oral
contraceptives; cyclosporine or tacrolimus;
sympathomimetics (decongestants, anorectics);
cocaine, amphetamines and other illicit drugs;
neuropsychiatric agents; erythropoiesis-
stimulating agents; cancer treatment (VEGF
inhibitors, Bruton tyrosine kinase inhibitors
and others), clonidine withdrawal; herbal
agents (Ma Huang, ephedra)
Renovascular
hypertension
0.1%–5% Resistant hypertension; hypertension of
abrupt onset or worsening or increasingly
difficult to control; flash pulmonary edema
(atherosclerotic); early-onset hypertension,
especially in women (fibromuscular
hyperplasia)
