Secondary Causes of Hypertension - Differential Diagnosis Algorithm

Hypertension - BP > 140/90 (>130/80 for DM)

Hypertensive urgency or emergency (any visit), Hypertension with end-organ damage or DM (visit 2), Diagnosis based on repeat clinic visits, Ambulatory blood pressure monitor, Self/Home pressure monitoring (visit 3+)

Consider secondary HTN

 • Onset <20yo, >50yo

 • NO FHx

 • Hypertensive urgency

 • Refractory hypertension (multi-drug resistance)

Renal Parenchymal Diseases

 • Glomerulonephritis

 • Nephritic syndrome

 • AKI/CKD

Mineralocorticoid Excess:

 • Conn's syndrome

 • NSAlDs

 • Licorice

 • Liddle's syndrome

 • Bilateral RAS

Vasoconstrictors:

 • Sympathetic nervous system (ie. cocaine, pheochromocytoma)

 • Steroids (Cushing's, exogenous steroids)

 • Renin-Angiotensin stimulation (OCP)

 • Alcohol abuse/ withdrawal

Anatomic Causes:

 • Aortic coarctation

 • Unilateral RAS

Metabolic Causes:

 • Hyperthyroidism

 • Hypercalcemia

 • Pheochromocytoma



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