Diagnostic Imaging Pathways - Hypertension
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Population Covered By The Guidance
This pathway provides guidance on the investigation of adult patients with hypertension who need investigation for causes of secondary hypertension.
Date reviewed: July 2018
Date of next review: July 2021
Published: March 2019
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SYMBOL | RRL | EFFECTIVE DOSE RANGE |
![]() | None | 0 |
![]() | Minimal | < 1 millisieverts |
![]() | Low | 1-5 mSv |
![]() | Medium | 5-10 mSv |
![]() | High | >10 mSv |
Images
Teaching Points
Teaching Points
- Secondary hypertension is uncommon and blanket screening for secondary hypertension is not routinely recommended
- If clinic blood pressure is ≥140/90mmHg, or hypertension is suspected, ambulatory and/or home monitoring should be offered to confirm the blood pressure level
- In cases of apparent resistant hypertension, it is important to specifically ask about medication compliance
- The initial assessment of patients with a new diagnosis of hypertension should include a thorough history and examination to elicit features that may suggest specific causes of secondary hypertension, as well as evidence of target organ damage. Basic screening tests include: urine dipstick, urinary albumin/creatinine ratio, fasting blood glucose, fasting lipid profile, serum urea, electrolytes, creatinine with eGFR, haemoglobin, fundoscopy and ECG (to assess for left ventricular hypertrophy)
- There are many causes of secondary hypertension and investigations should be targeted depending on the differential diagnosis
screening
Screening for Secondary Hypertension
- Only 5-10% of patients with hypertension have secondary hypertension 1
- Blanket screening for secondary hypertension is not routinely recommended 2
- If clinic blood pressure is ≥140/90mmHg, or hypertension is suspected, ambulatory and/or home monitoring should be offered to confirm the blood pressure level 3
- The initial assessment of patients with a new diagnosis of hypertension should include a thorough history and examination to elicit features that may suggest specific causes of secondary hypertension, as well as evidence of target organ damage. Basic screening tests include: urine dipstick, urinary albumin/creatinine ratio, fasting blood glucose, fasting lipid profile, serum urea, electrolytes, creatinine with eGFR, haemoglobin, fundoscopy and ECG (to assess for left ventricular hypertrophy) 3
- In cases of apparent resistant hypertension, it is important to specifically ask about medication compliance
- Screening for specific form(s) of secondary hypertension is recommended in certain circumstances:
- There are many causes of secondary hypertension and investigations should be targeted depending on the differential diagnosis
- Causes of secondary hypertension include: 4
- Renal parenchymal disease
- Renovascular disease, including renal artery stenosis due to fibromuscular dysplasia
- Primary hyperaldosteronism
- Obstructive sleep apnoea (although there is mixed evidence on the benefit of treatment)
- Drug or alcohol induced
- Rarer causes: 4
- Phaeochromocytoma
- Cushing’s syndrome
- Hypo/hyperthyroidism
- Aortic coarctation
- Primary hyperparathyroidism
- Congenital adrenal hyperplasia
- Other mineralocorticoid excess syndromes
- Acromegaly
Characteristics Suggestive of Secondary Hypertension |
Early onset <30 years 1,4,5 |
Resistant hypertension 1,4,6 – (>140/90mmHg despite three antihypertensive agents including a diuretic) |
Severe hypertension >180/110mmHg or hypertensive emergencies 1,4,5 |
Exacerbation of previously controlled hypertension 1,4-6 |
Clinical features specific to certain secondary causes 1,5,6 – including biochemical abnormalities (such as excessive hyperkalaemia 4), or renal dysfunction |
References
References
- Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J. 2014;35(19):1245-54. (Review article).View the reference
- Ng FL, Lobo MD. Investigation and management of adult hypertension. Heart. 2018. (Review article).View the reference
- National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults - 2016. Melbourne: National Heart Foundation of Australia; 2016. (Guideline). View the reference
- Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(6):1269-324. (Guideline). View the reference
- Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, et al. Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Can J Cardiol. 2017;33(5):557-76. (Guideline). View the reference
- Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. (Guideline). View the reference
Information for Consumers
Information for Consumers
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Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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