ABSTRACT
The Glasgow MRC Hypertension Research Unit suggests two groups commonly seen by the GP in whom investigation could be reasonably cost-effective. Except for coarctation, rare causes of secondary hypertension are detected by careful re-evaluation of cases with anomalous response to treatment, and are seldom obvious enough to be discovered through any initial routine. Every patient should be asked about stroke, heart attacks and diabetes in parents and siblings, and also their smoking habits, and anything known about their blood pressure, although such information is seldom reliable. This is important partly to assess risk, but chiefly to develop motivation. Some of the rarities are covered by initial routine baseline measurements. All antihypertensive drugs cause depression in some people, and this is rarely a risk worth taking. In fact, the main aim of both history and physical examination is not to make a diagnosis, but to record baselines against which to evaluate events.
