140/90 on 2 consecutive visits 2 weeks apart:
I. Primary (essential)
II. Secondary (exogenous substances, renal failure, sleep apnea, renovascular disease, primary aldosteronism, pheochromocytoma, Cushing syndrome).
History suggesting Secondary Causes:
- Onset of HTN befor 20 y.o. or after 50 y.o.
- hx of tachycardia, sweating, headache
- personal or family hx of renal disease
- HTN that is resistant (in a compliant patient)
- symptoms indicating sleep apnea
- drug use: amphetamine, cocaine, alcohol abuse
- medication use: oral contraceptives, estrogens, corticosteroids, NSAIDs
- hx of hirsutism or easy bruising
Physical Examination:
-elvated BP (2 consecutive visits 2 weeks apart);
exceptions:
-if SBP is 210 or more or
-a DBP 120 or more or
-end-organ damage.
Diagnostic Evaluation:
CBC, fasting serum glucose, K+, serum creatinine, UA, lipid profile, Calcium (with albumin), uric acid. ECG, chest xray, ambulatory BP (for patient with white-coat HTN), serum TSH.