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Additional investigations to exclude a secondary cause of hypertension might include:
- serum potassium - hypokalaemia may indicate diuretics, Conn's syndrome, renovascular disease, Cushing's syndrome
- serum calcium - for hypercalcaemia
- thyroid function tests
- 24 hour urinary VMA x 3
- MSU x 2 - look for cells, casts, protein
- urinary free cortisol
- renal ultrasound, IVU, renal arteriography
- CXR - look for evidence of end-organ damage
Ambulatory blood pressure monitoring provides an accurate profile of blood pressure fluctuations over a 24 hour period and control for the 'white coat effect'. For example, they may show the paroxysmal rise in blood pressure associated with phaeochromocytoma.
Last reviewed 05/2019