You doctor will ask you if you have any symptoms related to the medical illnesses that cause secondary hypertension. During a physical examination, your doctor will pay special attention to any sudden weight gain or weight loss, signs of extra fluid in your tissues, abnormal hair growth, and purple marks on your abdomen. You doctor also will check your abdomen for any abnormal masses, and he or she will use a stethoscope to listen for sounds of abnormal blood flow in your kidneys.
Depending on the results of your physical examination, your doctor will order additional tests to pinpoint the cause of your secondary hypertension. For suspected kidney disease, these tests may include blood tests for creatinine and blood urea nitrogen (BUN), urinalysis, and an ultrasound examination of your abdomen to evaluate the size of your kidneys. If there is concern that you may have renal artery stenosis, your doctor may order magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA). Occasionally, a test called a renal arteriogram is ordered.
For pheochromocytoma, your urine or blood may be analyzed for levels of catecholamines (the hormones epinephrine and norepinephrine). For Cushing's syndrome, urine or blood levels of cortisol are measured. For hyperparathyroidism, blood levels of parathormone, calcium and phosphate are measured. For hyperaldosteronism, a blood test for potassium and aldosterone levels are measured.
Coarctation of the aorta usually is suspected based on the younger age of the person, physical exam findings (blood pressure in the arms much higher than blood pressure in the legs) and specific changes seen on chest X-ray.