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December 5, 1977

Evaluation of Secondary Hypertension

JAMA. 1977;238(23):2494. doi:10.1001/jama.1977.03280240040007

To the Editor.—  In response to the article entitled "Diagnosis of Secondary Forms of Hypertension: A Comprehensive Protocol" by Grims et al (237:1331-1335, 1977), I would like to compliment the authors on an excellent protocol. In reviewing the algorithm for the evaluation of secondary hypertension, I would like to make special comment about the suggestion of intravenous pyelogram (IVP) on an outpatient basis before admission and early performance of renal angiograms before results of urinary biogenic amines are available.Commonly used radiopaque x-ray contrast media interfere with laboratory procedures for metanephrines and/or catecholamines if any of the various column chromatography procedures available are used in the performance of the test.1,2 It is believed that the x-ray contrast material (most commonly methylglucamine) blocks the binding sites in the column allowing the biogenic amines to pass through the column unbound. When the column is eluted, the biogenic amines will not be