Hypertension Differential Diagnoses

Updated: Nov 27, 2016
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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DDx

Diagnostic ConsiderationsAmbulatory blood pressure monitoring

In adults aged 50 years and older, the 2010 Institute for Clinical Systems Improvement (ICSI) guideline on the diagnosis and treatment of hypertension indicates that systolic blood pressure (SBP) should be the major factor to detect, evaluate, and treat hypertension. [4]

Ambulatory blood pressure monitoring (ABPM) is used to monitor daily and nocturnal blood pressure, providing information such as the percentage of elevated BP readings, overall BP load, and extent of BP fall during sleep. [2] In general, these readings are lower than those in a physician office setting and have a better correlation with target-organ injury. There is usually a 10-20% BP drop during the night. People who do not demonstrate such a decrease in BP are at increased risk for cardiovascular events. Patients with 24-hour BP greater than 135/85 mm Hg have been shown to have almost double the likelihood of having a cardiovascular event. [2]

Indications for ABPM include labile BP; a discrepancy between blood pressure measurements in and outside the physician’s office; and poor BP control. Ambulatory monitoring also identifies patients who have the distinct syndrome called white-coat hypertension, [49] in which a patient’s blood pressures reading at home and in the physician’s office vary widely. [59]

Problems to be considered include the following:

  • Steroid use
  • Use of over-the-counter or recreational sympathomimetic drugs
  • Pheochromocytoma
  • Acute vasculitis
  • Serotonin syndrome
  • Other central nervous system pathology
  • Coarctation of the aorta

Differential Diagnoses