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

Cardiovascular Risk Factors, Target Organ Damage, and Secondary Hypertension

This narrated slideshow gives a brief overview of what the proper history, physical, & lab assessment may uncover.


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), and Hypertensive Emergencies / Urgencies and Malignant Hypertension

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

C. Hypertensive Emergency, Malignant Hypertension, and Hypertensive Urgency

  1. Hypertensive Emergency – is marked hypertension with evidence of end-organ damage that requires immediate blood pressure control.
  2. Malignant Hypertension – is marked hypertension with papilledema, retinal hemorhhages or exudates and is considered a subset of a hypertensive emergency.
  3. Hypertensive Urgency – is marked hypertension that requires blood pressure control within hours but without evidence of end-organ damage.

Vaugh CJ, Delanty N. Hypertensive emergencies. Lancet 2000; 356: 411-17.

<< Initial Laboratory Testing as per JNC 7

Targets for Treatment of Essential Hypertension for Adults >>