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When to look for a secondary cause
Precise diagnosis of a secondary cause of hypertension--such as a kidney disorder, sleep apnea, or an adrenal tumor--usually requires special laboratory tests and procedures. Because these tests are expensive and inconvenient, they are not performed on everyone. Instead, they are done only when a thorough medical history and physical examination--or the results of routine laboratory tests--raise a strong suspicion of a secondary cause of hypertension.
The chance that an underlying disorder is responsible for hypertension is particularly likely when:
- Lifestyle modifications and a combination of three antihypertensive medications cannot control blood pressure.
- Blood pressure increases unexpectedly in someone whose blood pressure was previously well controlled.
- A hypertensive emergency occurs.
- Blood pressure increases to greater than 180/110 mm Hg in an individual who previously had normal blood pressure.
- Blood potassium levels drop for no particular reason.
- An individual experiences headache, perspiration, and palpitations.
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