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