| Condition | Clinical symptoms/signs beyond hypertension | Investigations |
| Renal artery stenosis | - Resistant hypertension
- Renal bruit
| - US of kidneys with Doppler evaluation or renal arteries
- US of the kidneys (one kidney smaller by >1.5 cm compared with contralateral)
- Duplex Doppler US of renal arteries
- Renal angiogram
|
| Renal parenchymal disease | - Mostly asymptomatic
- Strong family history (eg, adult polycystic kidney disease)
- Other conditions, such as systemic lupus, glomerulonephritis
| - Elevated serum creatinine
- Urinalysis for red blood cell casts or proteinuria
- May consider US of kidneys
- Evaluate for underlying conditions
|
| Primary aldosteronism | | - Hypokalemia
- Aldosterone and renin levels (may not be reliable in pregnancy)
- Adrenal imaging (CT or MRI)
|
| Pheochromocytoma | - Episodic headaches, sweating, palpitations, and flushing
- Labile blood pressure with severe hypertensive episodes
| - 24-hour urinary fractionated metanephrines and/or catecholamines
- Plasma fractionated metanephrines
- MRI of abdomen
|
| Cushing syndrome | - Moon facies, central obesity, thin skin, easy bruising
| - 24-hour urinary free cortisol
- Late night salivary cortisol
- Adrenal imaging
|
| Hypothyroidism or hyperthyroidism | - Symptoms of hypothyroidism or hyperthyroidism (eg, gain/loss of weight, cold/heat intolerance)
| |
| Coarctation of the aorta | - Hypertension in arms with low blood pressure in legs or delayed femoral pulses
| - Transthoracic echocardiogram
|
| Obstructive sleep apnea | - Obesity
- Daytime somnolence, fatigue
| |
| Drug-induced | - Oral contraceptives, nonsteroidal anti-inflammatory drugs, corticosteroids, cocaine, stimulants
| |
