‘ABCDE’ Mnemonic for Secondary Causes of Hypertension (after American Family Physician, 2003)

A
Accuracy
Alcohol
Apnea
Aldosteronism
Are the blood pressure readings accurate? Could chronic alcohol use be playing a role? Does the patient have obstructive sleep apnea? Does the patient have hypokalemia or other suggestions of primary hyperaldosteronism?

B
Bruits
Bad kidneys
Is there an abdominal bruit suggestive of renovascular hypertension? Does the patient have renal parenchymal disease (which can be cause or a consequence of hypertension)?

C
Catecholamines
Coarctation
Cushing's
Is the patient having palpitations, tachycardia, diaphoresis, headaches, and/or paroxysmal hypertension suggestive of pheochromocytoma? Are there decreased or delayed femoral pulses, or rib notching on chest x-ray suggestive of coarctation of the aorta? Any weight gain, hirstuism, amenorrhea, striae, or moon facies suggestive of Cushing's syndrome?

D
Drugs
Diet
Any use of sympathomimetics, corticosteroids, NSAIDs, oral contraceptive pills, MAOIs, or other drugs that can elevate blood pressure? Are excess dietary sodium or obesity contributing?

E
Endocrine
Erythropoietin
Is there untreated thyroid disease or hyperparathyroidism? Is there another disorder (COPD) leading to increased erythropoietin levels?

Abbr.: NSAID, non-steroidal anti-inflammatory drug; MAOI, monoamine oxidase inhibitor; COPD, chronic obstructive pulmonary disease