Examples of Physical Examination Findings and History Suggestive of Secondary HTN or Related to End Organ Damage Secondary to HTN
| Body System . | Finding, History . | Possible Etiology . |
|---|---|---|
| Vital signs | Tachycardia | Hyperthyroidism |
| PCC | ||
| Neuroblastoma | ||
| Decreased lower extremity pulses; drop in BP from upper to lower extremities | Coarctation of the aorta | |
| Eyes | Proptosis | Hyperthyroidism |
| Retinal changesa | Severe HTN, more likely to be associated with secondary HTN | |
| Ear, nose, throat | Adenotonsillar hypertrophy | SDB |
| History of snoring | Sleep apnea | |
| Height, weight | Growth retardation | Chronic renal failure |
| Obesity (high BMI) | Cushing syndrome | |
| Truncal obesity | Insulin resistance syndrome | |
| Head, neck | Elfin facies | Williams syndrome |
| Moon facies | Cushing syndrome | |
| Thyromegaly, goiter | Hyperthyroidism | |
| Webbed neck | Turner syndrome | |
| Skin | Pallor, flushing, diaphoresis | PCC |
| Acne, hirsutism, striae | Cushing syndrome | |
| Anabolic steroid abuse | ||
| Café-au-lait spots | Neurofibromatosis | |
| Adenoma sebaceum | Tuberous sclerosis | |
| Malar rash | Systemic lupus | |
| Acanthosis nigricans | T2DM | |
| Hematologic | Pallor | Renal disease |
| Sickle cell anemia | ||
| Chest, cardiac | Chest pain | Heart disease |
| Palpitations | ||
| Exertional dyspnea | ||
| Widely spaced nipples | Turner syndrome | |
| Heart murmur | Coarctation of the aorta | |
| Friction rub | Systemic lupus (pericarditis) | |
| Collagen vascular disease | ||
| Apical heavea | LVH | |
| Abdomen | Abdominal mass | Wilms tumor |
| Neuroblastoma | ||
| PCC | ||
| Epigastric, flank bruit | RAS | |
| Palpable kidneys | Polycystic kidney disease | |
| Hydronephrosis | ||
| Multicystic dysplastic kidney | ||
| Genitourinary | Ambiguous or virilized genitalia | Congenital adrenal hyperplasia |
| Urinary tract infection | Renal disease | |
| Vesicoureteral reflux | ||
| Hematuria, edema, fatigue | ||
| Abdominal trauma | ||
| Extremities | Joint swelling | Systemic lupus |
| Collagen vascular disease | ||
| Muscle weakness | Hyperaldosteronism | |
| Liddle syndrome | ||
| Neurologic, metabolic | Hypokalemia, headache, dizziness, polyuria, nocturia | Reninoma |
| Muscle weakness, hypokalemia | Monogenic HTN (Liddle syndrome, GRA, AME) |
| Body System . | Finding, History . | Possible Etiology . |
|---|---|---|
| Vital signs | Tachycardia | Hyperthyroidism |
| PCC | ||
| Neuroblastoma | ||
| Decreased lower extremity pulses; drop in BP from upper to lower extremities | Coarctation of the aorta | |
| Eyes | Proptosis | Hyperthyroidism |
| Retinal changesa | Severe HTN, more likely to be associated with secondary HTN | |
| Ear, nose, throat | Adenotonsillar hypertrophy | SDB |
| History of snoring | Sleep apnea | |
| Height, weight | Growth retardation | Chronic renal failure |
| Obesity (high BMI) | Cushing syndrome | |
| Truncal obesity | Insulin resistance syndrome | |
| Head, neck | Elfin facies | Williams syndrome |
| Moon facies | Cushing syndrome | |
| Thyromegaly, goiter | Hyperthyroidism | |
| Webbed neck | Turner syndrome | |
| Skin | Pallor, flushing, diaphoresis | PCC |
| Acne, hirsutism, striae | Cushing syndrome | |
| Anabolic steroid abuse | ||
| Café-au-lait spots | Neurofibromatosis | |
| Adenoma sebaceum | Tuberous sclerosis | |
| Malar rash | Systemic lupus | |
| Acanthosis nigricans | T2DM | |
| Hematologic | Pallor | Renal disease |
| Sickle cell anemia | ||
| Chest, cardiac | Chest pain | Heart disease |
| Palpitations | ||
| Exertional dyspnea | ||
| Widely spaced nipples | Turner syndrome | |
| Heart murmur | Coarctation of the aorta | |
| Friction rub | Systemic lupus (pericarditis) | |
| Collagen vascular disease | ||
| Apical heavea | LVH | |
| Abdomen | Abdominal mass | Wilms tumor |
| Neuroblastoma | ||
| PCC | ||
| Epigastric, flank bruit | RAS | |
| Palpable kidneys | Polycystic kidney disease | |
| Hydronephrosis | ||
| Multicystic dysplastic kidney | ||
| Genitourinary | Ambiguous or virilized genitalia | Congenital adrenal hyperplasia |
| Urinary tract infection | Renal disease | |
| Vesicoureteral reflux | ||
| Hematuria, edema, fatigue | ||
| Abdominal trauma | ||
| Extremities | Joint swelling | Systemic lupus |
| Collagen vascular disease | ||
| Muscle weakness | Hyperaldosteronism | |
| Liddle syndrome | ||
| Neurologic, metabolic | Hypokalemia, headache, dizziness, polyuria, nocturia | Reninoma |
| Muscle weakness, hypokalemia | Monogenic HTN (Liddle syndrome, GRA, AME) |
AME, apparent mineralocorticoid excess; GRA, glucocorticoid-remediable aldosteronism. Adapted from Flynn JT. Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol. 2001;12(2):177–188; National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2):555–576.
Findings that may be indicative of end organ damage related to HTN.