Cardiovascular Target Organ Damage Pulse-wave velocity, carotid intima-media thickness, and coronary artery calcium score provide noninvasive estimates Table 16. Historical Features Favoring Hypertension Cause Primary Hypertension Secondary Hypertension Gradual increase in BP, with slow rate of rise in BP BP lability, episodic pallor and dizziness (pheochromocytoma) Lifestyle factors that favor higher BP (eg, weight gain, high-sodium diet, decreased physical activity, job change entailing increased travel, excessive consumption of alcohol) Snoring, hypersomnolence (obstructive sleep apnea) Prostatism (chronic kidney disease due to post-renal urinary tract obstruction) Family history of hypertension Muscle cramps, weakness (hypokalemia from primary aldosteronism or secondary aldosteronism due to renovascular disease) Weight loss, palpitations, heat intolerance (hyperthyroidism) Edema, fatigue, frequent urination (kidney disease or failure) History of coarctation repair (residual hypertension associated with coarctation) Central obesity, facial rounding, easy bruisability (Cushing's syndrome) Medication or substance use (eg, alcohol, NSAIDS, cocaine, amphetamines) Absence of family history of hypertension BP indicates blood pressure; and NSAIDs, nonsteroidal anti-inflammatory drugs. Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e39 of vascular target organ injury and atherosclerosis.S7.2-1 High BP readings, especially when obtained several years before a noninvasive measurement, are associated with an increase in subclinical CVD risk.S7.2-2 S7.2-4 Although carotid intima-media thickness values and coronary artery calcium scores are associated with cardiovascular events, inadequate or absent information on the effect of improve- ment in these markers on cardiovascular events prevents their routine use as surrogate markers in the treatment of hypertension. LVH is a secondary manifestation of hypertension and independently predicts future CVD events. LVH is com- monly measured by electrocardiography, echocardiography, Left ventricular (LV) mass is associated with body size (particularly lean body mass), tobacco use, heart rate (inverse), and long-standing DM.S7.2-7 S7.2-9 BP low- ering leads to a reduction in LV mass. 