Sydney Renal Services - Renal Consulting, Hypertension, Dialysis, Transplantation
Who should be evauated for secondary hypertension ?
1.Severe or resistant hypertension (check compliance,Salt intake, etc..)        
2.An acute rise in blood pressure over a previously stable value
3.Proven age of onset before puberty
4.Age less than 30 years with no family history of hypertension and no obesity
Renovascular ?
  1. An acute elevation in serum creatinine of at least 30 percent from baseline after administration of ACEI or ARB. 
  2. Moderate to severe hypertension in a patient with atherosclerosis, with otherwise unexplained asymmetric renal size of (>1.5 cm)
  3. Recurrent episodes of flash pulmonary edema
  4. Onset of stage II hypertension after age 55 years
  5. Systolic or diastolic abdominal bruit (not very sensitive)

Renal Causes ?
Abnormal creatinine 
Abnormal urinalysis
Phaeo ?
Paroxysmal hypertension with Triad of headache (usually pounding), palpitations, and sweating.
 
Conns ?
Unexplained hypokalemia with urinary potassium wasting
Unexplained Metabolic alkalosis (both are not common though)
Steroid induced?
Cushingoid facies, central adiposity, proximal muscle weakness, and ecchymoses
May have a history of glucocorticoid use or intrinsic steroid excess.
OSA ?
Obese snorers with daytime somnolence, fatigue, and morning confusion
Coarctation of Aorta ?
Asymmetric hypertension in the arms (R>L) or with diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs.
 
 
OCPs, Hypothyroidism and Hyperparathyroidism
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