Surgical hypertension: Evaluation and treatment

Hypertension affects approximately 60 million people in the United States. Long-term sequelae include cardiac arterial disease, congestive heart failure, left ventricular hypertrophy, renal disease, cerebral vascular accidents, and retinopathy. The vast majority of people with hypertension have so-called primary or essential hypertension, whereby no single etiologic cause is known. When hypertension develops as a result of an identifiable cause, it is termed "secondary" hypertension, which should be suspected in patients who have medically refractory hypertension, an acute rise in blood pressure over a short period of time, are less than 30 years old and without a family history, and those with severe hypertension. Secondary hypertension can be divided into surgical and nonsurgical. Workup begins with a thorough history, physical examination, and focused laboratory and radiographic tests.