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Reading the NICE clinical guideline for Hypertension it says...

For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage, cardiovascular disease, renal disease or diabetes, consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage.

However it is not clear in the guidelines exactly what "specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage" would entail.

I understand that it is typical to carry out blood tests to look at kidney function, thyroid function, cholesterol and glucose levels; and that further tests such as a 12-lead ECG, echocardiography and renal ultrasound scan may be ordered if necessary to test for organ damage.

My question is what further tests would be performed by a specialist on a patient aged under 40 years with stage 1 hypertension and no evidence of target organ damage, cardiovascular disease, renal disease or diabetes? I have done several searches on Google but most of the papers I've read relate to patients who already have signs of organ damage or existing disease.

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Alongside full guidance released by NICE they also produce treatment pathways which give further advice - here is the treatment pathway for hypertension. You've listed most of the investigations that would be considered in your original question.

Investigations that may be considered as appropriate include:

  • Urine dipping for proteinuria or haematuria indicative of renal damage
  • Measuring of plasma urea and electrolytes and estimation of glomerular filtration rate, again as an indicator of renal damage
  • Measuring of plasma glucose, total cholesterol and LDL/HDL cholesterol to rule out additional risk factors as part of cardiovascular risk assessment - e.g. diabetes, hypercholestrolaemia
  • Fundoscopy to examine the retina for damage resulting from hypertension
  • 12 lead ECG to show any changes compatible with left ventricular hypertrophy
  • Scanning for the presence of a phaeochromocytoma if clinically suspected

You may also find the professional reference page on hypertension from patient.co.uk useful.

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