This document discusses the differential diagnosis of arterial hypertension. It outlines several types of hypertension including essential (primary) hypertension which has no identifiable cause but various risk factors, and secondary hypertension which can be caused by issues like chronic kidney disease, renal artery disease, endocrine disorders, and certain medications. It provides signs and symptoms as well as diagnostic tests to help differentiate between essential hypertension, renal artery stenosis, obstructive sleep apnea, primary hyperaldosteronism, hyperthyroidism, Cushing syndrome, pheochromocytoma, acromegaly, collagen vascular diseases, and gestational hypertension.

1. Differential diagnosis of Arterial
Hypertension
BY
Cheng Jin Ting
Group 85

2. Essential hypertension
• No identifiable cause
• Risk factor:
a) Genetic factor / family history
b) Obesity
c) Age
d) Excessive salt intake
e) Excessive alcohol consumption
f) Smoking
g) Inactivity
h) Stress

3. Classification of symptomatic/
secondary HTN
• nephrogenic hypertension (with chronic kidney
disease);
• vasorenal hypertension (associated with renal
artery disease)
• endocrine hypertension
• AH, caused by the lesion of large arterial vessels
• Neurogenic or central hypertension
• medicines and exogenous substances that can
cause hypertension

4. Clinical criteria for differential
diagnosis
• Collecting the anamnesis
– Pay attention to symptom (eg: face edema,
proteinuria and leukocyturia- glomerulonephritis)
– Family history: relatives with same disease
(hypertension maybe due to polycystic kidney
disease, diabetes and etc)
– Age: younger than 20 or older than 50 years old

5. Disease or condition Differentiating Signs/Symptoms Differentiating Tests
Drug induced •Acute intoxication, withdrawal,
or cravings with
cocaine/sympathomimetics use.
•History of treatment with or
ingestion of NSAIDs, oral
contraceptive pills,
sympathomimetics, herbal
medications (e.g., black cohosh,
capsicum, ma huang), licorice,
immunosuppressants
(cyclosporin, tacrolimus),
erythropoietin, higher dose
steroids, or chemotherapeutic
anti-endothelial growth factor
agents (bevacizumab).
•Drug toxicology screen
•Hypokalemia if excessive
licorice
Chronic Kidney
disease
•pruritus, edema, or change in
urine output
•High serum creatinine.
•Chronic anemia- CBC
•Renal ultrasound: sclerotic
or polycystic kidneys.

6. Disease/ condition Differentiating Signs/Symptoms Differentiating Tests
Renal artery stenosis •Typically younger patients with
difficult-to-control HTN.
•Renal artery bruits may be
present.
Renal duplex ultrasound or
magnetic resonance
angiogram (MRA) of renal
arteries confirms diagnosis.
Aortic coarctation Differential BP in upper and lower
extremities. Absent femoral
pulses.
CT, angiogram, or MRI
confirms diagnosis.
Obstructive sleep
apnoea
Typically obese patients with
daytime somnolence, snoring, or
choking during sleep.
Polysomnography shows
nocturnal oxygen
desaturation.
Primary
Hyperaldosteronism
(Conn’s syndrome)
Metabolic alkalosis, relative
hypernatremia, potassium
depletion, and elevated fasting
glucose
•Unprovoked hypokalemia.
•Plasma aldosterone high.
•Plasma renin low.
•Failure to suppress
aldosterone with salt
loading.

8. Disease/ Condition Differentiating sign/symptom Differentiating Test
Hyperthyroidism Heat intolerance, weight loss,
hyperphagia, palpitations.
•TSH suppressed
•Free thyroid hormones
elevated
Cushing Syndrome Classic symptoms and signs include
weight gain, moon face,
dorsicocervical fat pad, abdominal
striae, and easy bruisability.
Abnormal dexamethasone
suppression, 24-hour urine
free cortisol, and/or late-
night salivary cortisol.
Pheochromocytoma Paroxysms of HTN, flushing, and
headache
24-hour urine screen shows
elevated vanillylmandelic
acid, metanephrines,
and/or catecholamines.
Acromegaly Acral (hand/foot/jaw) enlargement Elevated insulin-like growth
factor-1 (IGF-1). Elevated
serum growth hormone
level, not suppressed by
glucose load.

12. Disease/ Condition Differentiating sign and symptom Differentiating test
Collagen Vascular
disease
Signs/symptoms of SLE,
rheumatoid arthritis, sclerodactly,
or Hx vasculitis.
Elevated ESR, abnormal
complement levels,
positive anti-DNA,
antiribonucleoprotein
(anti-RNP), anti-Smith
antibodies, positive
rheumatoid factor.
Gestational
Hypertension
Detected after 20 weeks'
gestation in a previously
normotensive patient.
Urinary albumin excretion
of 300mg/L/24 hours if
pre-eclampsia occurs