Table 9: Key Components of the History

Table 9:
Key Components of the History
Historical Query	Significance
Presentation of hypertension	The time course and presentation of the hypertension is important in establishing a differential. Rapid severe onset, or the sudden worsening of hypertension that had previously been easily controlled, suggests a superimposed condition. The last period in which a patient was known to be normotensive may aid in the differential.
Age	Newly diagnosed hypertension in a young patient should raise suspicion of a secondary cause. In the elderly patient, isolated systolic hypertension has significant pathophysiologic, prognostic, and treatment considerations, and is seldom secondary to another disorder.
Race	Compared with other ethnicities, young white patients are more likely to have hypertension that is secondary to an underlying cause.
Gender	Particular attention must be paid to women of reproductive age, and the possibility of pregnancy must be explored.
Medical history	Hypertension contributes to the morbidity and mortality from cardiac disease, renal disease, stroke, and neurologic disorders. Additionally, renal and cardiovascular disease may contribute to hypertension itself.
Surgical history	Particular attention should be paid to a history of cardiac, abdominal, or vascular surgeries.
Family history	Many patients with hypertension have a family history of the same condition. Within this subgroup, consideration should be given to excluding a family history of heritable kidney disease (eg, polycystic kidney disease, medullary sponge kidney) or the multiple endocrine neoplasia syndrome.
Social history	Hypertension can be caused by, and its control hampered by, alcohol use or abuse. Certain drugs of abuse (cocaine, amphetamines) are potent effectors of hypertension. Smoking may increase blood pressure and also multiplies the risks associated with hypertension.
Medications	Many medications can influence blood pressure. A detailed list of prescription and nonprescription medications that have been taken recently must be documented and analyzed for those that can increase blood pressure.
Review of systems	Evaluate the patient for weight changes and overall nutrition as well as salt intake, alcohol, nicotine, and caffeine use or abuse. In the patient with hypertension, inquire about potential end-organ damage such as symptoms suggestive of heart disease, stroke or neurologic disease, diabetes, vascular disease, edema, or skin changes.

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