Obstructive sleep 25% 50% Resistant hypertension; snoring; fitful sleep; breathing pauses during sleep; daytime sleepiness Obesity, Mallampati class III IV; loss of normal nocturnal BP fall Berlin Epworth Sleepiness overnight oximetry Polysomnography Drug or alcohol 2% 4% Sodium-containing antacids; caffeine; nicotine (smoking); alcohol; NSAIDs; oral contraceptives; cyclosporine or tacrolimus; sympathomimetics (decongestants, anorectics); cocaine, amphetamines and other illicit drugs; neuropsychiatric agents; erythropoiesis-stimulating agents; clonidine withdrawal; herbal agents (Ma Huang, ephedra) Fine tremor, tachycardia, sweating (cocaine, ephedrine, MAO inhibitors); acute abdominal pain (cocaine) Urinary drug screen (illicit drugs) Response to withdrawal of suspected agent Uncommon causes Pheochromocytoma/para 0.1% 0.6% Resistant hypertension; paroxysmal hypertension or crisis superimposed on sustained hypertension; spells, BP lability, headache, sweating, palpitations, pallor; positive family history of pheochromocytoma/ paraganglioma; adrenal incidentaloma Skin stigmata of neurofibromatosis (caf -au-lait spots; neurofibromas); Orthostatic hypotension fractionated metanephrines or plasma metanephrines under standard conditions (supine position with indwelling IV cannula) CT or MRI scan of abdomen/pelvis Cushing s <0.1% Rapid weight gain, especially with central distribution; proximal muscle weakness; depression; hyperglycemia Central obesity, moon face, dorsal and supraclavicular fat pads, wide (1-cm) violaceous striae, hirsutism dexamethasone suppression test 24-h urinary free cortisol excretion (preferably multiple); midnight salivary cortisol (Continued) Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e31 a higher level of high-density lipoprotein cholesterol and, within modest ranges of intake, a lower level of CHD than that associated with abstinence.S5.2.3-35 5.3. Childhood Risk Factors and BP Tracking BP distribution in the general population increases with age. Multiple longitudinal studies have investigated the relation- ship of childhood BP to adult BP. 