20th June 2026

Diagnosis and investigations

Diagnosis is generally based on a systolic blood pressure >180mmHg and a diastolic pressure >120mmHg.

Investigations may include:

• CT head: This may reveal a hemorrhagic stroke, but will not rule out an ischaemic stroke
• Fundoscopy: to look for signs of papilloedema
• Urine dipstick: to look for blood and protein in the urine
• Renal profile: deranged renal function may explain
• ECG: to look for left ventricular hypertrophy and rule out ischaemia
• Cardiac enzymes: to rule out myocardial infarction
• Urine drug screen: illicit drugs
• Thyroid function tests
• Plasma renin and aldosterone levels may point towards hyperaldosteronism as a cause
• Urine metanephrines for phaeochromocytoma
• 24-hour urinary cortisol for Cushing’s syndrome
• CXR
• CT aortogram if aortic dissection is suspected.
• Renal ultrasound / MRA