Table 10: Historical Clues

Table 10:
Historical Clues
Clue	Significance
Presence of kidney disease	Hypertension is often secondary to chronic renal insufficiency. Acute renal failure may be associated with an inability to excrete a sodium or water load, leading to intravascular volume expansion and the development of hypertension. Renal artery stenosis may present with significant hypertension that may be difficult to treat, as well as renal insufficiency, often without an active urine sediment.
Paradoxical hypertension after use of beta blockers	Patients with pheochromocytoma may exhibit sudden hypertension after beta-blocker use as a result of unopposed alpha-receptor stimulation.
In the setting of episodic or sustained hypertension, symptoms of headaches, palpitations, sweating, or dizziness; signs of pallor or flushing.	This constellation can be seen in multiple causes of secondary hypertension, including pheochromocytoma, thyroid disorders, carcinoid tumor, and drug abuse (eg, cocaine).
Symptoms of lethargy, mental clouding, or constipation; signs of slow, sustained reflexes on examination.	This constellation suggests hypothyroidism.
History of laboratory evidence of low or low-normal potassium.	Hyperaldosteronism can cause potassium wasting and hypertension.
Physical examination revealing edema, full facies, and skin stria.	These are classic findings in Cushing's disease, but may also be seen in Cushing's syndrome, nephrotic syndrome, or other causes of renal failure.
Examination findings of pulse or blood pressure differences between the limbs.	This suggests coarctation of the aorta; alternatively, it suggests peripheral vascular disease, and one must then have a heightened concern for renal artery stenosis.
Examination revealing a bounding pulse	High-output heart disease with associated hypertension. May also be observed in hyperthyroidism.
History of anemia or laboratory data confirming anemia.	Anemia may be seen in chronic renal failure, which is often associated with hypertension. Anemia is also common in autoimmune disorders associated with thyroid disease or kidney disease.
History of difficulties or complications undergoing surgery or anesthesia.	Patients with pheochromocytoma can develop severe paroxysms during these procedures.
History of dizziness or paroxysmal hypertension specifically associated with torso movements, exertion, or coitus.	Pheochromocytomas may respond to mechanical stress induced by these activities with release of catecholamines.
Family history of multiple endocrine neoplasia syndrome.	Pheochromocytomas are found in certain multiple endocrine neoplasia syndromes.
History of autoimmune disease or family history of the same.	Autoimmune disorders can be associated with thyroid disease or kidney disease, which in turn can contribute to hypertension.

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