HYPERTENSION
HYPERTENSION: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is there systolic hypertension only? The presence of an elevated systolic pressure only would suggest hyperthyroidism, aortic insufficiency, and atherosclerotic aortitis.
- Is the hypertension paroxysmal? The presence of paroxysmal hypertension should suggest a pheochromocytoma.
- Is there a normal or low blood pressure in the lower extremities? These findings would suggest a coarctation of the aorta.
- Is there a flank mass? The presence of a flank mass should suggest hypernephroma, hydronephrosis, and polycystic kidneys.
- Are there abnormalities of the urinary sediment? These findings suggest glomerulonephritis, collagen disease, Henoch-Schönlein purpura, and chronic nephritis. All primary care physicians should have this capability in their office.
DIAGNOSTIC WORKUP
Routine diagnostic tests include a CBC, sedimentation rate, chemistry panel, total and high-density lipoprotein (HDL) cholesterol, a VDRL test, urinalysis including microscopic, a urine culture with colony count and sensitivity, and an EKG, chest x-ray, and flat plate of the abdomen for kidney size.
If these are normal, a nephrologist should be consulted before undertaking expensive diagnostic tests. It may be wise to observe the results of treatment before further testing also.
Additional tests that may be ordered are an intravenous pyelogram, a 24-hr urine catecholamine, a serum cortisol, a plasma renin level, a 24-hr urine aldosterone determination, a cystoscopy, and retrograde pyelography. A 24-hr free cortisol may be more useful in diagnosing Cushing's syndrome than serum free cortisone. Renal angiography used to be done more frequently, but should be considered in sudden onset of hypertension in the elderly and in hypertension that is resistant to treatment.
Twenty-four-hr blood pressure monitoring can be useful both in diagnosis and in evaluating the results of therapy. Magnetic resonance angiography is a good noninvasive alternative to renal angiography.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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