Signs/symptoms | Possible secondary hypertension cause | Diagnostic test options |
---|---|---|
Arm to leg systolic blood pressure difference > 20 mm Hg Delayed or absent femoral pulses Murmur | Coarctation of the aorta | Magnetic resonance imaging (adults) Transthoracic echocardiography (children) |
Increase in serum creatinine concentration (≥ 0.5 to 1 mg per dL [44.20 to 88.40 μmol per L]) after starting angiotensin-converting enzyme inhibitor or angiotensin receptor blocker Renal bruit | Renal artery stenosis | Computed tomography angiography Doppler ultrasonography of renal arteries Magnetic resonance imaging with gadolinium contrast media |
Bradycardia/tachycardia Cold/heat intolerance Constipation/diarrhea Irregular, heavy, or absent menstrual cycle | Thyroid disorders | Thyroid-stimulating hormone |
Hypokalemia | Aldosteronism | Renin and aldosterone levels to calculate aldosterone/renin ratio |
Apneic events during sleep Daytime sleepiness Snoring | Obstructive sleep apnea | Polysomnography (sleep study) Sleep Apnea Clinical Score with nighttime pulse oximetry |
Flushing Headaches Labile blood pressures Orthostatic hypotension Palpitations Sweating Syncope | Pheochromocytoma | 24-hour urinary fractionated metanephrines Plasma free metanephrines |
Buffalo hump Central obesity Moon facies Striae | Cushing syndrome | 24-hour urinary cortisol Late-night salivary cortisol Low-dose dexamethasone suppression |