Table 7:

Detailed evaluation for secondary causes of hypertension⁸

Clinical diagnosis	Confirmatory evaluation
Glomerulonephritis	Serum C3, C4, ASO Autoantibodies (ANA/anti dsDNA/ANCA) Renal biopsy
Reflux nephropathy	Micturating cystourethrogram Nuclear scan (DMSA/MAG3)
Renovascular disease	Plasma renin/aldosterone levels Kidney doppler (low sensitivity) CT/MR renal angiography (>95% sensitive) Digital subtraction angiography – Gold standard
Pheochromocytoma	Urine and plasma metanephrines MIBG scan CT/MRI abdomen Arteriography and caval catecholamine sampling
Hyperthyroidism or hypothyroidism	Thyroid stimulating hormone, free T4 and free T3
Endocrine causes Cushings syndrome Primary aldosteronism	Overnight dexamethasone suppression test, 24 hour urinary free cortisol Plasma aldosterone renin ratio
Coarctation of aorta	Echocardiogram
Neuroblastoma	Vanillylmandelic acid (VMA), homovanillic acid (HMA)
Monogenic Hypertension	Aldosterone and renin levels Genetic testing

ASO: Antistreptolysin O, ANA: Antinuclear antibody, dsDNA: Double-stranded deoxyribonucleic acid, ANCA: Anti-neutrophil cytoplasmic antibody, DMSA: Dimercaptosuccinic acid, MAG3: Mercaptuacetyltriglycine, CT: Computed tomography, MR: Magnetic resonance, MIBG: Metaiodobenzylguanidine, MRI: Magnetic resonance imaging