target="_blank" rel="nofollow" href="#fb3_img_img_7a749386-0a10-57ff-9346-f55dc1575166.png"/> anatomical abnormalities of the circulatory system such as narrowing of the aorta or renal artery
polycythaemia, in which blood stickiness is significantly increased due to over-production of red blood cells
Conn’s syndrome, in which there are high levels of aldosterone hormone
phaeochromocytoma, due to a tumour that secretes excessive amounts of adrenaline hormone and noradrenaline
Cushing’s syndrome, due to excessive exposure to corticosteroids – either from overactive adrenal glands or from steroid drug treatment
acromegaly, due to excessive production of growth hormone by the pituitary gland
hyperparathyroidism, due to overactivity of the four parathyroid glands in the neck which, if not treated, raises blood calcium levels and can damage the kidneys.
SECONDARY HYPERTENSION DUE TO DRUGS
Several drugs – both those available on prescription and those bought over the counter – can put your blood pressure up while they are being taken. These include:
nasal decongestants (e.g. ephedrine), taken to relieve a blocked nose
non-steroidal anti-inflammatory drugs (e.g. ibuprofen), taken to relieve aches and pains in the muscles and joints which – can raise BP by 5–10 mm Hg
oral corticosteroids, taken for severe inflammatory conditions such as asthma or rheumatoid arthritis
the combined oral contraceptive pill (containing both oestrogen and progestogen hormones), which can raise BP after several years’ use – recent research suggests that the average increase in BP is around 2.8/1.9 mmHg. In some women, however, rapid and more severe rises in BP can occur
monoamine-oxidase inhibitors – drugs sometimes used to treat severe depression – can cause sudden rises in BP if you eat cheese or other foods containing tyramine while on medication
carbenoxolone – a synthetic version of liquorice, sometimes used to treat stomach ulcers – can put BP up as it can trigger retention of sodium and water; a similar effect can also occur if you eat too much liquorice which has not been deglycerrizhinated.
Diagnosing High Blood Pressure
ROUTINE EXAMINATIONS
If your doctor finds your blood pressure is raised, you will probably have the following examinations:
checking your blood pressure at least twice during the first visit
feeling your pulse to see how regular and strong it is
checking pulses in your groin, feet and ankles to make sure your peripheral circulation is intact – pressing on the skin of your lower legs and then letting go will show how quickly blood flows back into the blanched area
feeling your chest to see where the tip of your beating heart is detectable – this gives a good indication of whether or not your heart is enlarged
listening to your heart with a stethoscope to check for heart murmurs and to listen to your heart beat rhythm
listening to your lungs to check for signs of fluid build-up on the chest
listening to your neck and abdomen with a stethoscope to detect any noises due to turbulent blood flow through damaged carotid or renal arteries
examining the backs of your eyes to look for any signs of arterial damage (see below).
If your blood pressure remains consistently raised, you may have the following routine investigations:
chest x-ray – to check the size and shape of the heart and to look for evidence of congestive heart failure with fluid build-up on the lungs
ECG – heart tracing to look for signs of left-ventricular thickening, irregular heartbeat or evidence that the heart muscle is struggling
analysis of a urine sample – to look for protein and sugar, which would suggest blood vessels in the kidney are damaged
blood test for urea and electrolytes – to check kidney function and your salt balance
blood test for fasting blood lipids – to see if your blood cholesterol or other fat levels are raised.
If your doctor suspects your blood pressure is due to an underlying cause, you may have one or more of the following tests carried out:
If your potassium level is low, and you are not on diuretic treatment, you may have a hormone problem leading to high blood pressure. You will therefore have blood tests taken to check levels of other hormones such as aldosterone, cortisol and renin.
Blood tests to assess kidney function (creatinine clearance rate).
An intravenous urogram – a substance that shows up on x-ray is injected into your blood stream and a series of x-rays taken. This shows any narrowing of your renal arteries, how well your kidneys concentrate the dye in the urine, and outlines your urinary system to show up anatomical abnormalities or shrinkage of the kidneys.
Ultrasound of your kidneys.
Blood tests to measure catecholamine levels or measurement of
