HYPERTENSION PROTOCOL: INITIAL VISIT

1. RATIONALE
   1. This protocol will assist in the differentiation between essential hypertension and renal artery stenosis to aid in the identification of patients in need of referral to nephrology to prevent further renal damage from an unidentified renal artery stenosis. The design of the protocol for UTI encompasses these principles.

 

2. SYMPTOMS
   1. HYPERTENSION
      1. Blood pressure >140/90 mmHg
      2. Other possible subjective symptoms
         1. Headache
         2. Visual changes
         3. Dyspnea
         4. Chest pain
         5. Sensory or motor deficit
   2. RENAL ARTERY STENOSIS
      1. Onset of hypertension age >55 years or <30 years
      2. History of accelerated, malignant, or resistant hypertension
      3. History of unexplained kidney dysfunction
      4. History of multivessel coronary artery disease
      5. History of other peripheral vascular disease
      6. Abdominal bruit
      7. Sudden or unexplained recurrent pulmonary edema
      8. Other possible factors
         1. Absence of family history of hypertension
         2. Other bruits
         3. History of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist (ARB)............. Continue