Table 1 Major types of secondary hypertension, their suggestive findings and examinations necessary for differential diagnosis

From: Chapter 12. Secondary hypertension

Underlying disease or condition Suggestive findings Examinations necessary for differential diagnosis
Renal parenchymal hypertension Proteinuria, hematuria, kidney dysfunction, a history of kidney disease Seroimmunological test, renal ultrasonography/CT, kidney biopsy
Renovascular hypertension Young age, rapid blood-pressure increase, abdominal vascular bruit, hypokalemia PRA, PAC, renal Doppler ultrasonography, renal scintigraphy, angiography
Primary aldosteronism Weakness of the limbs, nocturnal pollakiuria, hypokalemia PRA, PAC, adrenal CT, saline or furosemide load test, adrenal venous blood collection
Cushing's syndrome Central obesity, moon face, striated skin, hyperglycemia Cortisol, ACTH, abdominal CT, brain (pituitary) MRI
Pheochromocytoma Paroxysmal/labile hypertension, palpitation, headache, sweating, neurofibroma Blood/urinary catecholamines and their metabolites, abdominal ultrasonography/CT, MIBG scintigraphy
Hypothyroidism Bradycardia, edema, hypoactivity, increases in the levels of lipids, CPK and LDH Thyroid hormone/autoantibody, thyroid ultrasonography
Hyperthyroidism Tachycardia, sweating, weight loss, a decrease in the cholesterol level Thyroid hormone/autoantibody, thyroid ultrasonography
Hyperparathyroidism Hypercalcemia Parathyroid hormone
Aortic coarctation Differences in blood pressure between the upper and lower limbs, vascular murmurs Thoracic (abdominal) CT, MRI/MRA, angiography
Brainstem vascular compression Resistant hypertension, facial spasm, trigeminal neuralgia Brain (medullary) MRI/MRA
Sleep apnea syndrome Snoring, daytime sleepiness, obesity Overnight sleep monitoring
Drug-induced hypertension Previous drug administration, resistant hypertension, hypokalemia Confirmation of previously administered drugs
  1. Abbreviations: LDH, lactate dehydrogenase; MRA, magnetic resonance angiography; PAC, plasma aldosterone concentration; PRA, plasma renin activity.