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Significant Hypertension

Please click here for a visual summary of the latest NICE guidance, Aug 2019.

Please note, same day specialist assessment is reserved for those with a BP over (either systolic or diastolic in excess of) 180/120 mmHg AND

retinal haemorrhage or papilloedema (accelerated hypertension) or

life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury or

suspected pheochromocytoma (for example, labile or postural hypotension, headache, palpitations, pallor, abdominal pain or diaphoresis)*

*More on clinical presentation of pheochromocytoma

Symptoms and signs of pheochromocytoma include the following:

  • Headache

  • Sweating

  • Palpitations

  • Tremor

  • Nausea

  • Weakness

  • Pallor

  • Anxiety, sense of doom

  • Epigastric pain

  • Flank pain

  • Constipation

  • Weight loss

The classic history of a patient with a pheochromocytoma includes spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension. These 4 characteristics together are strongly suggestive of a pheochromocytoma. In the absence of these 3 symptoms and hypertension, the diagnosis may be excluded. (Blake 2020

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