| Disorder | Suggestive clinical features |
| General | - Severe or resistant hypertension
- An acute rise in blood pressure over a previously stable value
- Proven age of onset before puberty
- Age less than 30 years with no family history of hypertension and no obesity
|
| Renovascular disease | - Unexplained creatinine elevation and/or acute and persistent elevation in serum creatinine of at least 50% after administration of ACE inhibitor, ARB, or renin inhibitor
- Moderate to severe hypertension in a patient with diffuse atherosclerosis, a unilateral small kidney, or asymmetry in kidney size of more than 1.5 cm that cannot be explained by another reason
- Moderate to severe hypertension in patients with recurrent episodes of flash pulmonary edema
- Onset of hypertension with blood pressure >160/100 mmHg after age 55 years
- Systolic or diastolic abdominal bruit (not very sensitive)
|
| Primary kidney disease | - Elevated serum creatinine concentration
- Abnormal urinalysis
|
Drug-induced hypertension: - Oral contraceptives
- Anabolic steroids
- NSAIDs
- Chemotherapeutic agents (eg, tyrosine kinase inhibitors/VEGF blockade)
- Stimulants (eg, cocaine, methylphenidate)
- Calcineurin inhibitors (eg, cyclosporine)
- Antidepressants (eg, venlafaxine)
| - New elevation or progression in blood pressure temporally related to exposure
|
| Pheochromocytoma | - Paroxysmal elevations in blood pressure
- Triad of headache (usually pounding), palpitations, and sweating
|
| Primary aldosteronism | - Unexplained hypokalemia with urinary potassium wasting; however, more than one-half of patients are normokalemic
|
| Cushing's syndrome | - Cushingoid facies, central obesity, proximal muscle weakness, and ecchymoses
- May have a history of glucocorticoid use
|
| Sleep apnea syndrome | - Common in patients with resistant hypertension, particularly if overweight or obese
- Loud snoring or witnessed apneic episodes
- Daytime somnolence, fatigue, and morning confusion
|
| Coarctation of the aorta | - Hypertension in the arms with diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs
- Left brachial pulse is diminished and equal to the femoral pulse if origin of the left subclavian artery is distal to the coarct
|
| Hypothyroidism | - Symptoms of hypothyroidism
- Elevated serum thyroid stimulating hormone
|
| Primary hyperparathyroidism | |
