During my General Internal Medicine outpatient clinic experience, many patients were being referred for hypertension. When working up a patient for hypertension, it is important to rule out secondary causes. A thorough history is required to screen for these causes. Personally, I use the acronym ‘OCHAPS’ to remember the secondary causes of hypertension:
O: Obstructive sleep apnea. This is one of the most common secondary causes. Patients can be screened for this using the STOP-BANG questionnaire. Diagnosis is confirmed with AHI>=5 on polysomnogram. Treatment includes: 10% weight loss, CPAP, dental appliances, and uvulopalatopharyngoplasty.
C: Cushing’s disease. This results in hypercortisolism. Assess the patient for the following features/signs: abdominal striae, Buffalo hump, hyperglycaemia, moon facies. Investigations include 24-hour urine cortisol. Management varies depending on the underlying cause.
H: Hyperaldosteronism. Suspect this in patients with hypokalemia. Investigations include aldosterone/renin levels and ratios. Management varies depending on the underlying cause.
A: Aortic coarctation. Suspect this in younger patients. Assess using upper limb vs. lower limb blood pressure difference. Management is usually surgical.
P: Pheochromocytoma. Suspect in patients presenting with the 5 Ps: pain (headache), palpitations, perspiration, pressure (high), and pallor. Investigations include 24-hour urine total metanephrines. Management is usually surgical.
S: Stenosis of renal arteries. Investigations include abdominal ultrasound. Management is usually surgical.
Resources:
- Evaluation of secondary hypertension. Uptodate
- Overview of hypertension. Uptodate
-IL-
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