When to Suspect Secondary Hypertension

Abstract

A thorough history and physical examination together with selected, office-based laboratory studies are recommended in the evaluation of each new patient with hypertension (Table 13-1). This initial evaluation is designed to assess the presence or absence of target organ damage and cardiovascular disease, to identify other cardiovascular risk factors or comorbid conditions that may have an impact on the prognosis and selection of therapy, and to provide valuable clues to other secondary causes of hypertension. When preliminary examination affords no clues, an extensive search for secondary and possibly curable causes of hypertension is unproductive, unnecessarily costly, and, on occasion, may be hazardous. This chapter does not address the problem of alcohol excess, which represents the most common cause of reversible hypertension in our society, or oral contraceptive therapy, which may be associated with significant hypertension in a small number of women. Table 13-2 summarizes the information to be gained from the initial clinical evaluation regarding selected secondary causes of hypertension, and this information is discussed further in this chapter.