Clinical Services

In addition to being evaluated by our multidisciplinary team of clinical hypertension specialists, we offer the following services for world class diagnosis and treatment of complex hypertension.

Laboratory Diagnostics

  • Screening for signs of kidney dysfunction contributing to high blood pressure including blood and urine tests.
  • Blood and urine studies for signs of disorders of the endocrine system, including primary and secondary forms of hyperaldosteronism, hypercortisolism, pheochromocytoma, thyroid disease, and hyperparathyroidism.
  • 24-hour urine studies offering precise measurement of dietary sodium intake, and evaluation of hormones to detect endocrine tumors or disorders that may be the underlying cause of hypertension.
  • Toxicology screens for substances that contribute to hypertension and provide a picture of medication compliance

Genetic Testing

  • Genetic testing for familiar causes of monogenic hypertension include glucocorticoid-remediable hyperaldosteronism and syndromes of apparent mineralocorticoid excess.
  • Genetic counseling services and whole exome sequencing are also available through Stanford's Clinical Genomic Service.

Imaging

  • Abdominal CT - We offer computer tomography scans of the abdomen with thin cuts through the adrenal glands to assess for adenomas, and we offer angiograms for visualization of renovascular disease.
  • Renal ultrasound - Both colleagues in Diagnostic Radiology and Vascular Surgery offer doppler of the renal arteries as a screening test for renovascular disease such as fibromuscular dysplasia or atherosclerotic renal artery stenosis.
  • Magnetic Resonance Imaging (MRI/MRA) of the abdomen - High-density MRI of the adrenal glands, kidneys, and renal arteries. The Stanford Hypertension Center multidisciplinary team has developed an innovative protocol for abdominal imaging. This novel approach has detected adrenal tumors and renal abnormalities missed on outside imaging.

 

Procedural Diagnostics

  • Captopril Suppression Test - offering biochemical confirmation of excess aldosterone production, a hormone that causes high blood pressure
  • Adrenal Vein Sampling - A procedure conducted by our Interventional Radiologists to assess lateralization of adrenal hormone (e.g. adrenal or cortisol) secretion; identifies candidates for surgical treatment of hypertension
  • Renal Vein Renin Sampling - A procedure conducted by our Interventional Radiologists to asses lateralization of renin production; confirms existence of rare renin-producing tumors. 
  • Ambulatory Blood Pressure Monitoring - A device worn for 24-48 hours on the upper arm to record blood pressure at home during the day and night to classify different forms of elevated blood pressure including paroxysmal, labile, white-coat, masked, and nocturnal hypertension.
  • Autnonomic Testing - A procedure performed by our Neurology colleagues to assess for autonomic nerve disorders that lead to conditions such as labile hypertension, orthostatic hypertension, or orthostatic hypotension.
  • Polysomnography (Sleep Studies) - An overnight procedure assessing the degree of obstructive or central sleep apnea that can cause and/or exacerbate resistant hypertension. Our patients are formally evaluated by our sleep medicine specialists before and after polysomnography. If a device is recommended to treat sleep apnea, we also follow-up to evaluate the efficacy of the device.

Sleep Apnea Screening

Symptom checklist for sleep related breathing disorders:

Sleep related breathing disorders (sleep apnea) include snoring, obstructive sleep apnea, central sleep apnea, and upper airway resistance syndrome. Patients with these conditions may experience a lack of oxygen and fragmented sleep, causing a stress response in the body that results in high blood pressure. Treating sleep apnea can improve blood pressure control. Untreated sleep apnea has also been associted with cognitive deficits, diabetes, heart failure, stroke, abnormal heart rhythms, fatty liver disease, and increased mortality.

Consider asking your doctor about screening for sleep related breathing disorders if you notice any of the following:

  • You or your partner have noticed you snoring
  • You or your partner witness stop breathing at night or waking up gasping for air
  • Morning headaches
  • Sensation of feeling unrested after a full night of sleep
  • Excessive daytime sleepiness

 

To help you determine if you have abnormal daytime sleepiness, take the quiz.

Personal Data Tracking

Through Stanford’s MyHealth patient portal, individuals can securely transmit home blood pressure readings, heart rate and body weight to providers. These readings then become integrated into the patient’s electronic health records for more accurate, convenient, personalized diagnostics and assessment of treatment efficacy.

Personal tracking is currently enabled to sync with any blood pressure tracker linked to Apple’s HealthKit and Withings devices, with ongoing efforts to expand to other devices. Patients may also manually input home blood pressure readings.