I. Labs: General for All Patients

  1. Urinalysis
  2. Complete Blood Count (Hemoglobin or Hematocrit minimum)
  3. Fasting lipid profile
  4. Chemistry Panel (Chem7, SMA7)
    1. Fasting Glucose
    2. Serum Potassium (Consider primary Aldosteronism if Hypokalemia - even borderline low)
    3. Renal Function: Serum Creatinine, BUN
  5. Electrocardiogram

II. Labs: Optional Studies (as indicated)

  1. Serum Calcium
  2. Uric Acid
  3. Chest XRay (evaluate for coarctation, heart size)
  4. 24 hour Urine Creatinine
  5. 24 Hour Urine Protein

III. Evaluation: Secondary Hypertension

  1. Indications
    1. Hypertension Onset under age 30 (and esp. unde age 12) or over age 60
    2. Hypertension refractory to aggressive treatment
    3. Previously controlled Hypertension now refractory
    4. Accelerated Hypertension or Malignant Hypertension
    5. Signs OR symptoms of secondary Hypertension
  2. Labs
    1. Aortic Coarctation
      1. Arm to leg systolic Blood Pressure difference (abnormal if >20 mmHg)
      2. Chest XRay (notching of the lower rib borders)
      3. Echocardiogram (Children)
      4. MRI Chest (Adults)
    2. Cushing's Disease
      1. 24 hour Urine Cortisol
      2. Late night Salivary cortisol
      3. Low dose Dexamethasone Suppression Test
    3. Pheochromocytoma
      1. 24h Urine Metanephrine
      2. Plasma free metanephrines
    4. Renal parenchymal disease
      1. Renal Ultrasound
    5. Renal Artery Stenosis
      1. Serum Creatinine increased by 0.5 to 1 mg/dl after starting ACE Inhibitor or ARB
      2. Renal bruit may be present on exam
      3. Doppler Ultrasound of renal arteries or
      4. CT Angiography or MR Angiography
    6. Primary Aldosteronism (strongly consider if Hypokalemia)
      1. Morning aldosterone to plasma renin ratio >20-30
      2. Serum Potassium decreased

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Ontology: Hypertensive disease (C0020538)

Definition (NCI) A disorder characterized by a pathological increase in blood pressure; a repeatedly elevation in the blood pressure exceeding 140 over 90 mm Hg.
Definition (MEDLINEPLUS)

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

  • 120/80 or lower is normal blood pressure
  • 140/90 or higher is high blood pressure
  • Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness.
Definition (CSP) persistantly high arterial blood pressure.
Definition (MSH) Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Definition (NCI) Pathological increase in blood pressure; a repeatedly elevated blood pressure exceeding 140 over 90 mmHg.
Concepts Disease or Syndrome (T047)
MSH D006973
ICD9 997.91, 401-405.99
ICD10 I10-I15.9 , I10, I10-I15
SnomedCT 38341003, 155295004, 194756002, 155302005, 266287006, 195537001, 194794002, 194757006, 194760004
English Hypertension, BLOOD PRESSURE HIGH, HYPERTENSION, HYPERTENSION ARTERIAL, HYPERTENSIVE DISEASES, Hypertension, NOS, Hypertensive disease, NOS, Hypertensive disease NOS, Hypertensive diseases, [X]Hypertensive diseases, hypertension, Hypertension, arterial, Hypertensive cardiovascular disease or syndrome, Systemic hypertension, Hypertensive disorder, systemic arterial, hyperpiesia, hyperpiesis, systemic HTN, systemic hypertension (diagnosis), systemic hypertension, hypertensive disorder, vascular hypertension, 3-02 HYPERTENSIVE DISEASES, hbp, high bp, htn, (Hypertensive disease) or (hypertension) (disorder), Hypertensive disease (disorder), Hypertensive disease NOS (disorder), Hypertension arterial, Blood pressure high, HBP, HT, Hypertension NOS, [X]Hypertensive diseases (disorder), Surg comp - hypertension, HTN, HIGH BLOOD PRESSURE, PRESSURE, HIGH BLOOD, BLOOD PRESSURE, HIGH, High Blood Pressure, INCREASED BLOOD PRESSURE, BLOOD PRESSURE, INCREASED, Hypertension [Disease/Finding], hypertensive vascular disease, arterial hypertension, arterial hypertension systemic, blood high pressure, high blood pressure disorder, systemic arterial hypertension, hypertensive disease, Hypertensive diseases (I10-I15), high blood pressure, High blood pressure, Hyperpiesia, Hyperpiesis, Hypertensive vascular degeneration, Hypertensive vascular disease, BP - High blood pressure, High blood pressure disorder, Systemic arterial hypertension, HBP - High blood pressure, BP+ - Hypertension, HT - Hypertension, Hypertensive disorder, systemic arterial (disorder), Hypertensive disorder, HTN - Hypertension, blood pressure; high, high; arterial tension, high; blood pressure, (Hypertensive disease) or (hypertension), Raised blood pressure (disorder), Blood Pressure, High, Blood Pressures, High, High Blood Pressures, Vascular Hypertensive Disorder, Hypertensive disease, HYPERTENSIVE DISEASE
French HYPERTENSION ARTERIELLE, Pression artérielle élevée, PAH, Hypertension SAI, TH, HYPERTENSION, TENSION ARTERIELLE E, Hypertension chronique, Hypertension permanente, Hypertension artérielle, Hypertension
Portuguese HIPERTENSAO, Hipertensão arterial NE, Hipertensão arterial, Pressão arterial alta, HYPERTENSAO ARTERIAL, PRESSAO SANGUINEA ELEVADA, Pressão Arterial Alta, Pressão Sanguínea Alta, Hipertensão
Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, Hypertension, Hypertensive disease, High blood pressure, (Hypertensive disease) or (hypertension), Hypertension NOS, HIPERTENSION ARTERIAL, [X]enfermedades hipertensivas (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, SAI (trastorno), enfermedad hipertensiva, SAI, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertension, Hipertensión, Presión Sanguínea Alta, Presion Sanguinea Alta
German HYPERTONIE, Hypertonie, arteriell, Blutdruck, hoch, HBP, HT, Hypertonie NNB, BLUTDRUCK HOCH, HYPERTONIE ARTERIELL, Hypertension, Hypertonie
Dutch hypertensie NAO, hoge bloeddruk, arteriële hypertensie, bloeddruk; hoog, hoog; arteriële druk, hoog; bloeddruk, hypertensie, Bloeddruk, hoge, Hypertensie
Italian Ipertensione (HT), Ipertensione NAS, Pressione del sangue elevata, Ipertensione, Pressione sanguigna alta, Ipertensione arteriosa
Japanese 動脈性高血圧, 高血圧NOS, コウケツアツ, コウケツアツNOS, ドウミャクセイコウケツアツ, 高血圧, 高血圧症
Swedish Högt blodtryck
Czech hypertenze, Arteriální hypertenze, Vysoký krevní tlak, Hypertenze NOS, Hypertenze, vysoký krevní tlak
Finnish Kohonnut verenpaine
Russian GIPERTENZIIA, GIPERTONICHESKAIA BOLEZN', KROVIANOE DAVLENIE VYSOKOE, ГИПЕРТЕНЗИЯ, ГИПЕРТОНИЧЕСКАЯ БОЛЕЗНЬ, КРОВЯНОЕ ДАВЛЕНИЕ ВЫСОКОЕ
Croatian HIPERTENZIJA
Polish Nadciśnienie
Hungarian Arteriás hypertonia, Hypertensio, HT, RR magas, Hypertonia k.m.n., Magas vérnyomás