Study note

Specialised investigations and history in hypertension

THE CONTEXT

All hypertensive patients require limited routine investigations, with additional testing appropriate for younger patients or resistant hypertension.

•

Additional investigations are appropriate in patients younger than 40 years or those with resistant hypertension.

•

Record family history, exercise, salt intake, smoking and other risk factors.

•

A careful history can identify drug-induced or alcohol-induced hypertension and symptoms of secondary causes or complications.

•

Paroxysmal headache, palpitation and sweating may suggest phaeochromocytoma.

•

Chest X-ray can detect cardiomegaly, heart failure and coarctation of the aorta.

•

Ambulatory blood pressure recording assesses borderline or white coat hypertension.

•

Echocardiography detects or quantifies left ventricular hypertrophy.

•

Renal ultrasound assesses possible renal disease, while renal angiography detects or confirms renal artery stenosis.

•

Urinary catecholamines are used to detect possible phaeochromocytoma.

•

Urinary cortisol and a dexamethasone suppression test are used to detect possible Cushing syndrome.

•

Plasma renin activity and aldosterone are used to detect possible primary aldosteronism.

NEETx

Learn. Practise. Remember.