SUMMARY OF WORK-UP FOR HYPERTENSION
For Everyone w/ HTN *
* See Below for Clues generated by this work-up |
For These Patients
Order
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Suspect RAS If:
Order:
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CONDITIONS TO SUSPECT FROM BASIC WORK-UP
1. Clues from History:- Paroxysms of severe H/A + palpitations + diaphoresis → r/o Pheochromocytoma
- Excessive daytime drowsiness → r/o Sleep Apnea (if also snores)
- Meds (chronic): esp. Estrogens, NSAIDs, Anti-depressants, Decongestants, Stimulants
- Cushingoid Features → r/o Cushing’s
- Diastolic murmur at L sternal border → r/o Aortic Insufficiency
- Abdominal Bruit: systolic + diastolic → Renal Artery Stenosis
- Pulses (palpate brachial & femoral pulses simultaneously): Delayed femoral → r/o Coarctation of Aorta
- Optic Fundoscopy → abnormalities suggest severe HTN (r/o lots of causes)
- ↑ Creatinine suggests Renal Disease
- ↑ Calcium suggests Hyperparathyroidism
- ↓ Potassium → r/o 1° Aldosteronism
- ↑ Glucose → r/o Cushing’s if stigmata on PE (otherwise, just Dx diabetes)
4. TSH: ↑ = Hypothyroidism, ↓ = Hyperthyroidism
5. Urinalysis:- Proteinuria suggests underlying Renal Disease
- Proteinuria + Hematuria → Glomerulonephritis
- Red cell casts → Gomerulonephritis
TESTS TO R/O SECONDARY CAUSES OF HYPERTENSION
** Hypo- / Hyperthyroidism → TSH ** Renal Disease → Creatinine; Proteinuria; Renal Ultrasound ** 1° Aldosteronism → Ratio of plasma Aldosterone-to-Renin Activity ** Medications → History ** Hyperparathyroidism → Serum calcium (and albumin); serum PTH ** Pheochromocytoma → 24 hr. Urine for Catecholamines, Metanephrines ** Cushing’s Syndrome → 24 hr. Urine for Cortisol ** Obstructive Sleep Apnea → Polysomnogram ** Renal Artery Stenosis → Duplex Ultrasound; MR / CT Angiogram ** Aortic Insufficiency → Cardiac auscultation; Echocardiogram ** Coarctation of Aorta → Echocardiogram; MR / CT Angiogram.