During history taking for hypertension, which finding indicates possible secondary hypertension?

• A. Normal fundus
• B. Abdominal bruit
• C. No risk factors
• D. Normal blood pressure

Answer: (B)

A finding that points toward secondary hypertension is an abdominal bruit. This sounds like turbulent blood flow from a narrowed renal artery, which suggests renovascular hypertension due to renal artery stenosis. The reduced perfusion of the kidney triggers the RAAS system, often leading to high blood pressure that can be resistant to standard therapy. In contrast, a normal fundus, no identifiable risk factors, or normal blood pressure do not indicate a secondary cause; they’re more consistent with essential hypertension or well-controlled disease.