Etiology Primary hypertension 95% of all cases Secondary hypertension – 5% of all cases – Chronic renal disease – most common White coat hypertension – Common? – Caused by  vascular resistance – Harmless??

Causes of secondary hypertension: Renal: Chronic parenchymal diseases (3-5%). Renal artery stenosis (1-2%).

Causes of secondary hypertension: Endocrinal: – Primary hyper aldosteronism< 0.3%. – Pheochromocytoma <0.3%. – Hypo or hyperthyroidism. – Cushing syndrome.

Causes of secondary hypertension: Aortic coartication. Drug induced. Pregnancy.

Aim of evaluation: Establishment of diagnoses. Assessment of CV risk. Evaluation of TOD. Diagnoses of secondary hypertension.

Patient Evaluation Hypertension Smoking Obesity Physical inactivity Dyslipidemia Diabetes Assess lifestyle and identify other CV risk factors or concomitant disorders:

Assess lifestyle and identify other CV risk factors or concomitant disorders Microalbuminuria or GFR < 60 ml/min Age – Males > 55 yrs – Females > 65 yrs Family history of CVD – Males < 55 yrs – Females < 65 yrs

Patient Evaluation Sleep Apnea Drug-induced Chronic kidney disease Primary aldosteronism Renal vascular disease Reveal identifiable causes of hypertension:

Chronic steroid therapy and Cushing’s syndrome Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disorders

Patient Evaluation Heart – LVH or CHF – Angina or prior MI – Prior coronary revascularization Brain – Stroke or transient ischemic attack (TIA) Assess the presence or absence of target organ damage and CVD

Chronic kidney disease Peripheral arterial disease Retinopathy