Who is tested for secondary hypertension?

Because secondary hypertension is relatively rare, and screening for causes can be expensive and time-consuming, not every patient with high blood pressure will be tested for the condition. Your healthcare provider will test you if they feel there is a strong probable case. There are several factors that help determine if you should be screened for secondary hypertension. These factors include:

  • Age: Patients under 30 years who have high blood pressure with no family history or other risk factors of high blood pressure
  • Resistant hypertension: Patients who have resistant hypertension have high blood pressure that has not improved despite optimal treatment with at least three blood pressure medications
  • Obesity: Overweight patients with high blood pressure that does not respond to treatment over time
  • Signs or symptoms suggestive of an underlying condition
  • Laboratory abnormalities such as low potassium or high calcium

What tests will my healthcare provider do to diagnose secondary hypertension?

Your healthcare provider will focus on the symptoms and signs of conditions that could cause secondary hypertension. Physical signs could include:

  • Change in body weight
  • Fluid buildup (swelling)
  • Abnormal hair growth
  • Stretch marks on the skin of the abdomen
  • Abnormal blood flow to the kidneys

Blood tests may also be done. These could include:

  • Creatinine and blood urea nitrogen (BUN) tests to examine kidney function
  • Calcium and potassium levels in the blood
  • Thyroid function tests

Imaging tests could also be done to look at the size and structure of organs. These tests may include:

  • An ultrasound of the kidneys to check their size and blood flow
  • A contrast tomography (CT) scan or magnetic resonance imaging (MRI) to check the adrenal glands, or an arteriogram to track blood flow to the kidneys

Your blood pressure will also be monitored to see if it dips at different points in the day or night.

Last reviewed by a Cleveland Clinic medical professional on 05/03/2019.


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  • Centers for Disease Control and Prevention. High Blood Pressure. Accessed 5/8/2019.
  • Rimoldi SF, Scherrer U, and Messerli FH. Secondary arterial hypertension: when, who, and how to screen? European Heart Journal doi:10.1093/eurheart/eht, accepted 21 November 2013. Accessed 6/26/2020.
  • Winter, N. Diabetes and Hypertension: Evaluation and Management. Contemporary Diabetes, DOI 10.1007/978-1-60327-357-2_2, (McFarlane SI and Bakrin GI, eds.), pp. 15-24. Springer Science+Business Media New York 2012. Accessed 5/8/2019.

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