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Evaluation of secondary hypertension

Stephen Textor, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure control since many forms of secondary hypertension cause "treatment-resistant" hypertension [1]. Patients likely to have essential (idiopathic or primary) hypertension undergo a relatively limited evaluation because extensive laboratory testing is usually of little value. (See "Initial evaluation of the hypertensive adult".)

By contrast, patients who have clinical clues suggesting the possible presence of secondary hypertension should undergo a more extensive evaluation. If secondary hypertension is present, the most effective treatment strategy often is one that is focused upon the specific mechanism underlying the hypertension. In addition, some of these disorders can be cured, leading to partial or complete normalization of the blood pressure.

Because it is not cost effective to perform a complete evaluation for secondary hypertension in every hypertensive patient, it is important to be aware of the clinical clues that suggest secondary hypertension. The identification of patients who should undergo an evaluation for secondary hypertension will be reviewed here. Testing methods for renovascular hypertension and treatment of unilateral and bilateral atherosclerotic renal artery stenosis are discussed separately. (See "Establishing the diagnosis of renovascular hypertension" and "Treatment of unilateral atherosclerotic renal artery stenosis" and "Treatment of bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney".)


There are a number of general clinical clues that, in isolation or in combination, are suggestive of secondary hypertension (table 1):

Severe or resistant hypertension. Resistant hypertension is defined as the persistence of hypertension despite concurrent use of adequate doses of three antihypertensive agents from different classes, including a diuretic. (See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Definitions'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 01, 2017.
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