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[Rational diagnostic approach in hypertension].

P Greminger1

  • 1Medizinische Poliklinik, Departement für Innere Medizin, Universitätsspital Zürich.

Praxis
|January 1, 2004
PubMed
Summary

Most high blood pressure cases are essential hypertension with unknown causes. Secondary hypertension, often linked to chronic kidney disease, can be diagnosed with clinical evaluation and simple tests.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiology

Background:

  • Hypertension is a condition with numerous potential causes.
  • Approximately 95% of hypertension cases are classified as primary or essential, with unknown etiology.
  • Secondary hypertension, accounting for the remaining 5%, stems from identifiable underlying conditions.

Purpose of the Study:

  • To outline the diagnostic approach for identifying secondary hypertension.
  • To emphasize the importance of clinical evaluation in diagnosing hypertension.
  • To differentiate the diagnostic workup for various secondary causes of hypertension.

Main Methods:

  • Review of diagnostic procedures for hypertension.
  • Clinical examination and patient history taking.
  • Basic laboratory tests for initial screening.
  • Targeted investigations for specific secondary causes.

Main Results:

  • Chronic renal disease is the most prevalent cause of secondary hypertension.
  • Renovascular, endocrine, cardiovascular, and neurologic disorders are rare causes (<1%).
  • Initial clinical assessment and simple lab tests can detect most secondary hypertension cases.

Conclusions:

  • A thorough anamnestic evaluation and clinical examination are crucial for diagnosing secondary hypertension.
  • Extensive workup for renovascular hypertension is indicated only upon clinical suspicion.
  • Diagnostic procedures for endocrine hypertension require careful consideration due to potential high costs.

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