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What A Proper History, Physical, and Lab Assessment May Uncover

FYI | Possible Laboratory Tests of the Future

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1. C-Reactive Protein and LDL Levels

Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and lowdensity lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557-65.

2. Homocysteine

Welch, G., and Loscalzo, J. Homocysteine and atherothrombosis. N Engl J Med. 1998 Apr 9;338(15):1042-50

Cardiovascular Risk Factors, Target Organ Damage, and Secondary Hypertension

Audio Link   This audio segment gives a brief overview of what the proper history, physical, & lab assessment may uncover. (Running Time: 2:58)

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Cardiovascular Risk Factors

  • Hypertension*
  • Cigarette smoking
  • Obesity* (BMI >30 kg/m2)
  • Physical inactivity
  • Dyslipidemia*
  • Diabetes mellitus*
  • Microalbuminuria or estimated GFR <60 ml/min
  • Age (older than 55 for men, 65 for women)
  • Family history of premature CVD
    (men under age 55 or women under age 65)

*components of metabolic syndrome

Target Organ Damage

  • Heart
    •  Left ventricular hypertrophy
    •  Angina or prior myocardial infarction
    •  Prior coronary revascularization
    •  Heart failure
  • Brain
    •  Stroke or transient ischemic attack
  • Chronic kidney disease
  • Peripheral arterial disease
  • Retinopathy

Identifiable Causes of Secondary Hypertension

  • Sleep apnea
  • Drug-induced or related causes
  • Chronic kidney disease
  • Primary aldosteronism
  • Renovascular disease
  • Chronic steroid therapy and Cushing’s syndrome
  • Pheochromocytoma
  • Coarctation of the aorta
  • Thyroid or parathyroid disease

The focus of this module is on essential hypertension, which makes up 95 – 99% of the hypertension in the United States. Secondary hypertension is far less prominent but should be suspected based on your clinical assessment of the patient and when blood pressure fails to be controlled despite optimal medical management. You can visit “the library” for more information on these conditions.

FYI | Metabolic Syndrome & Selected Identifiable Causes of Hypertension (Secondary Hypertension)

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A. Metabolic Syndrome

Deen, D. Metabolic Syndrome: Time for Action. Am Fam Physician. 2004 Jun 15;69(12):2875-82.

B. Selected Identifiable Causes of Hypertension (Secondary Hypertension)

1. Pheochromocytoma

Westphal SA. Diagnosis of a pheochromocytoma. American Journal of the Medical Sciences. 329(1):18-21, 2005 Jan. UI: 15654175

2. Primary Aldosteronism

Young WF Jr. Minireview: primary aldosteronism--changing concepts in diagnosis and treatment. Endocrinology. 144(6):2208-13, 2003 Jun.
UI: 12746276

3. Renal Artery Stenosis

Radermacher J. Haller H. The right diagnostic work-up: investigating renal and renovascular disorders. Journal of Hypertension - Supplement. 21 Suppl 2:S19-24, 2003 May. UI: 12929903

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