eMedicine Specialties > Nephrology > Hypertension and the Kidney

Hypertension: Differential Diagnoses & Workup

Author: Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital
Coauthor(s): Claude Kortas, MD, Program Director, Associate Professor, Department of Medicine, University of Western Ontario, Canada
Contributor Information and Disclosures

Updated: Aug 6, 2008

Differential Diagnoses

Adrenal Adenoma
Hyperaldosteronism, Primary
Aortic Coarctation
Hypertension and Pregnancy
Aortic Dissection
Hypertension, Malignant
Apnea, Sleep
Hypertensive Heart Disease
Atherosclerosis
Hyperthyroidism
Atherosclerotic Disease of the Carotid Artery
Obstructive Sleep Apnea-Hypopnea Syndrome
Cardiomyopathy, Cocaine
Pheochromocytoma
Cardiomyopathy, Hypertrophic
Renal Artery Stenosis

Workup

Laboratory Studies

  • Unless a secondary cause for hypertension is suspected, only the following routine laboratory studies should be performed:
    • CBC count, serum electrolytes, serum creatinine, serum glucose, uric acid, and urinalysis
    • Lipid profile (total cholesterol, low-density lipoprotein [LDL] and high-density lipoprotein [HDL], and triglycerides)
  • Additional tests described below are indicated when specific clinical situations warrant further investigation.
    • Microalbuminuria is an early indication of hypertensive nephrosclerosis and is also a marker for a higher risk of cardiovascular morbidity and mortality. Present recommendations suggest that individuals with type I diabetes should be screened for microalbuminuria. Usefulness of this screening in hypertensive patients without diabetes has not been established.
    • Plasma renin activity (PRA) is performed to detect evidence of primary hyperaldosteronism. Low renin values confirm the diagnosis of primary hyperaldosteronism; however, hypokalemia may be associated with a form of hypertension, but it is not often present.
    • Determination of sensitive thyroid-stimulating hormone (TSH) level excludes hypothyroidism or hyperthyroidism as a cause of hypertension.

Imaging Studies

  • Echocardiography: The limited echocardiography study, rather than the complete examination, may detect LVH more frequently than electrocardiography. The main indication for limited echocardiography is evaluation for end organ damage in a patient with borderline high blood pressure. Therefore, the presence of LVH despite normal or borderline high blood pressure measurements requires antihypertensive therapy.
  • Imaging studies for renovascular stenosis: If the history suggests renal artery stenosis and if a corrective procedure is considered, further radiologic investigations are performed.

Other Tests

  • Routine testing includes electrocardiograms.
  • Ambulatory blood pressure monitoring: Indications for ambulatory blood pressure monitoring include labile blood pressure, a discrepancy between blood pressure measurement inside and outside the physician's office, and poor blood pressure control. Ambulatory monitoring also identifies patients who have the distinct syndrome called white coat hypertension.

More on Hypertension

Overview: Hypertension
Differential Diagnoses & Workup: Hypertension
Treatment & Medication: Hypertension
Follow-up: Hypertension
References
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References

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Further Reading

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Contributor Information and Disclosures

Author

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Claude Kortas, MD, Program Director, Associate Professor, Department of Medicine, University of Western Ontario, Canada
Claude Kortas, MD is a member of the following medical societies: American Society of Nephrology, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

L Michael Prisant, MD, FACC, Director of Hypertension and Clinical Pharmacology Unit, Professor of Medicine, Department of Medicine, Medical College of Georgia
L Michael Prisant, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Clinical Pharmacology, American College of Forensic Examiners, American College of Physicians, American Heart Association, and American Medical Association
Disclosure: Abbott Grant/research funds Investigator; Boehringer-Ingelheim Grant/research funds Other; Eli Lilly None Investigator; Novartis None Investigator; Abbott, Boehringer-Ingelheim, Forest, Gilead, Merck, Merck/Schering-Plough, Novartis, Oscient, Sciele, SunTech Medical Consulting fee Consulting; Abbott, Boehringer-Ingelheim, Merck, Merck/Schering-Plough, Novartis, Oscient Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George R Aronoff, MD, Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine
George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Roche Honoraria Consulting

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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