Consider if

• Onset < 30 yo
• Randomly worsened of previous well controled
• !Malignant HTN (220/130) (220/130), HTN emergency
• Refractory to 3+ anti-hypertensive medication (one has to be Thiazide-like Diuretics)
• S/S pertinent for secondary cause

Etiology

• Anti-hypertensive Medication in-adhenrence (top cause)

• Medical causes (see abolve)

  • Renal: RAS - Renal Artery Stenosis
  • CoA - Aortic Coarctation, !AD - Aortic Dissection (bilateral BP)
  • OSA - Obstructive Sleep Apnea
  • Hypertensive Disorder of Pregnancy

• Endocrine causes of Hypertension

  • Investigate adrenal causes if:
  • Aldosterone → Hyperaldosteronism ↑,
  • Cortisol (inhibits AHD) → Cushing’s syndrome ↑
  • SNS activation → Pheochromocytoma↑
  • GH → Acromegaly (↑GN)
  • TH → Thyrotoxicosis ↑(hyperthyroidism)

• Medication causes of Hypertension (Cautious in older adult)

  • NSAID
  • SSRI/SNRI
  • β3 Agonist → Mirabegron (Myrbetriq®) (for overactive bladder)
  • Oral Corticosteroid (OCS)

Special Population

<aside> 🌐

• Past !Stroke (CVA) or TIA + ↑High BP </aside>