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Restless/intermittent sleep, recurrent awakenings daytime sleepiness, fatigue, impaired concentration

Increased neck circumference

Apnoea, snoring

Obesity

Signs and symptoms

Atrial fibrillation Non-dipping or reverse dipping pattern 24 h ABPM Obstructive sleep apnoea Pathophysiology

Intermittent upper airway obstruction during sleep

Overnight ambulatory polysomnography

Diagnosis

Treatment

Weight loss CPAP Mandibular advancement devices

Figure 15 Summary of obstructive sleep apnoea as a common form of secondary hypertension. AF, atrial fibrillation; ABPM, ambulatory blood pressure monitor; CPAP, continuous positive airway pressure.

Renovascular hypertension

Migraine, pulsatile tinnitus (FMD)

Pulmonary oedema (bilateral)

Multisite atherosclerosis

Unexplained small kidney or kidney asymmetry

Age <40 years (FMD)

Signs and symptoms Pathophysiology

Diagnosis

Treatment

Significant renal artery stenosis:

Atherosclerosis Fibromuscular dysplasia Rare causes

Renal doppler ultrasound Abdominal CT-Angio or MRI

Vascular bruits Arterial dissections and/or aneurysms (FMD)

Medical: optimal CV risk management Interventional: renal angioplasty without (FMD) or with stenting (atherosclerosis)

Acute    eGFR after RAS blocker

GFR, albuminuria,    renin

Age >60 years with acute change in BP or flash pulmonary oedema (atherosclerosis)

Figure 14 Summary of renovascular disease as a common form of secondary hypertension. CT-Angio, computed tomography angiography; CV, cardiovascular; FMD, fibromuscular dysplasia; GFR, glomerular filtration rate; MRI, magnetic resonance imaging; RAS, renin–angiotensin system.

ESC Guidelines                                                                                                                                                                                          3953

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