Cause of hypertension?

While the stage of hypertension is not stated, a renal parenchymal or renovascular cause seem unlikely in the absence of abnormality on ultrasound, renal function tests, urinalysis and CT angiography. Done appropriately, a normal CT angiogram would rule out branch renal vessel stenosis and scars secondary to reflux nephropathy. Patients with endocrine or monogenic causes of hypertension generally show low potassium levels and low, rather than elevated plasma renin activity.

Raised levels of renin are consistent with the diagnosis of essential hypertension. However, the importance of this investigation as a screening test for essential hypertension in children is unclear. Information on family history of hypertension, preserved nocturnal dipping and altered metabolic profile (dyslipidemia, raised HbA1c or hyperuricemia), if present, shall support the diagnosis. The absence of end organ damage (normal urinalysis, absence of left ventricular hypertrophy) is reassuring and supports the diagnosis of essential hypertension. Additional steps should include screening for hypertensive retinopathy, home or ambulatory blood pressure monitoring, lipid profile and blood sugar, HbA1c and uric acid levels.