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Table 10 Clinical clues and diagnostic tests of secondary hypertension

From: 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I–epidemiology and diagnosis of hypertension

Diseases Clinical clues   Laboratory test  
  History Physical diagnosis Chemistry Screening test Additional test
Parenchymal renal diseases Urinary tract infection or obstruction, analgesic abuse, familial history of polycystic kidney disease Abdominal mass (polycystic kidney disease) Proteinuria, hematuria, pyuria, reduced glomerular filtration rate Renal US Further studies for kidney diseases
Renal artery stenosis Fibromuscular dysplasia, premature hypertension (female), atherosclerotic diseases, sudden onset or worsening of hypertension, resistant hypertension, recurrent pulmonary edema Abdominal bruit Rapid worsening of renal function (spontaneous or after ACE inhibitor or ARB treatment) Kidney size difference >1.5 cm, duplex Doppler US, CT Magnetic resonance imaging, digital subtraction angiography
Primary aldosteronism Muscle weakness, premature hypertension, familial history of premature stroke (<40 years old) Arrhythmia (severe hypokalemia) Hyperkalemia (spontaneously or after treatment by ACE inhibitor or ARB), incidental adrenal mass Aldosterone renin ratio (after correction of hypokalemia and disappeared effect of ACE inhibitor or ARB) Suppression test by saline infusion, fludrocortisone, and/or captopril, adrenal CT, adrenal vein sampling
Pheochromo-cytoma Paroxysmal hypertension, emergency visit by persistent hypertension with headache, sweat, and/or pallor, familial history Café-au-lait lesion and neurofibro-matosis neurofibroma Incidental adrenal mass (extraadrenal mass in some cases) Metanephrine and/or nor-metanephrine in 24-h urine Abdominal and/or pelvic CT or magnetic resonance imaging, radioisotope scan using meta-iodobenzyl-guanidine
Cushing syndrome Rapid weight gain, polyuria, polydipsia, psychiatric problems Central obesity, mood face, buffalo hump, abdominal striae, hirsutism Hyperglycemia Cortisol in 24-h urine Dexamethasone suppression test