Secondary hypertension (secondary high blood pressure) — Comprehensive overview covers causes, risk factors and treatments. Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. A secondary etiology may be suggested by. Secondary hypertension occurs in a significant proportion of adult patients (~10 %). In young patients, renal causes (glomerulonephritis) and coarctation of the.
For information about the SORT evidence rating system, go to https: Magnetic resonance imaging adults Transthoracic echocardiography children. Computed tomography angiography Doppler ultrasonography of renal arteries Magnetic resonance imaging with gadolinium contrast media. Apneic events during sleep Daytime sleepiness Snoring. Polysomnography sleep study Sleep Apnea Clinical Score with nighttime pulse oximetry. Buffalo hump Central obesity Moon facies Striae. Information from references 4 through First, the physician should confirm that the patient's blood pressure has been accurately measured using correct positioning with an appropriately sized cuff.
Excessive consumption of sodium, licorice, or alcohol is known to increase blood pressure. Buspirone Buspar , carbamazepine Tegretol , clozapine Clozaril , fluoxetine Prozac , lithium, tricyclic antidepressants. Information from references 5 and The most common etiologies in children, in whom 70 to 85 percent of cases of hypertension have a secondary cause, 4 , 30 , 31 are different from those in older persons 32 ; therefore, an age-based approach to the differential diagnosis is recommended.
Blood pressure cutoffs in children are based on sex, age, and height percentile 4 ; charts with appropriate blood pressure ranges for children can be found at http: Table 3 summarizes the most common causes of secondary hypertension by age, 2 , 3 , 30 — 34 and Figure 1 outlines a suggested approach to the initial evaluation of patients with suspected secondary hypertension. Physicians must remember that these are not absolute categories; there may be overlap of causes between age groups.
The remainder of our article discusses the use of specific strategies for patients in different age groups. Information from references 2 , 3 , and 30 through Algorithmic approach to the initial evaluation of patients with suspected secondary hypertension.
Renal parenchymal disease is the most common cause of hypertension in preadolescent children. Sometimes the resulting hypertension is not apparent until young adulthood, 35 so this etiology should still be considered in the differential diagnosis outside of childhood.
Initial evaluation for suspected renal parenchymal disease should include measurement of blood urea nitrogen and creatinine levels, a urinalysis, urine culture, and renal ultrasonography. Coarctation of the aorta is the second most common cause of hypertension in children, and is two to five times more common in boys.
Discrepancies between bilateral brachial, or brachial and femoral blood pressures, suggest coarctation Table 1. Transthoracic echocardiography is sufficient for diagnosis in children, given their smaller body habitus, and is useful to concurrently evaluate for left ventricular hypertrophy. Fibromuscular dysplasia is a vascular disorder of unknown etiology that has a predilection for the renal arteries, causing narrowing that leads to decreased renal perfusion.
In young adults, particularly women, fibromuscular dysplasia is one of the most common causes of secondary hypertension. Compared with patients without such a finding, those in whom a renal artery bruit is detected have a relative risk of approximately 5. Although angiography is the diagnostic standard for detecting renal artery stenosis, it is invasive and should not be used as an initial diagnostic test. However, MRI does not use radiation and can determine the physiologic degree of stenosis.
MRI can also be used for patients with poor renal function, particularly when used without gadolinium, although with a slight decrease in sensitivity and specificity. When likelihood ratios were not supplied in referent article, they were calculated based on sensitivity and specificity data provided.
Information from references 9 , 10 , and 12 through Thyroid hormone affects cardiac output and systemic vascular resistance, which in turn affect blood pressure. Hypothyroidism can cause an elevation in diastolic blood pressure, whereas hyperthyroidism can cause an isolated elevation of systolic blood pressure, leading to a widened pulse pressure.
Thyroid-stimulating hormone is a sensitive marker used for initial diagnosis of either condition. Primary aldosteronism, also referred to as hyperaldosteronism, is actually a group of conditions, including aldosterone-producing adenomas and bilateral idiopathic hyperaldosteronism. Non—medication-induced hypokalemia should lead the physician to suspect aldosteronism, although this abnormality occurs in only 30 percent of patients. Obstructive sleep apnea is a notable cause of secondary hypertension, 38 particularly in to year-olds, but less so in those 60 years and older.
Pheochromocytomas are rare tumors responsible for approximately 0. Testing for a pheochromocytoma is not part of the initial evaluation for secondary hypertension unless specific symptoms are suggestive Table 1. Most presentations of Cushing syndrome hypercortisolism are iatrogenic from prescribed corticosteroids, which again highlights the importance of reviewing the patient's medications.
However, only 20 percent of patients with iatrogenic Cushing syndrome have hypertension. Options for initial testing include hour urinary free cortisol, low-dose dexamethasone suppression, or late-night salivary cortisol tests, although ultimately these patients should be referred to an endocrinologist for a complete evaluation.
Renal artery stenosis secondary to atherosclerotic disease affects older adults. It should be suspected in those who develop hypertension after 50 years of age, have known atherosclerosis elsewhere, have unexplained renal insufficiency, or have a rapid deterioration in kidney function i.
However, a recent randomized controlled trial found that medical management was as effective as revascularization in patients whose physician believed they did not have a clear indication for revascularization, with similar rates of blood pressure control and cardiovascular deaths, and without the associated complications of surgery. Hypertension can be a major cause of renal parenchymal damage, particularly in older adults, which in turn leads to worsening hypertension. Alternatively, renal damage from another process, such as diabetes mellitus, can result in hypertension.
Evaluation for possible chronic renal failure should include calculating the estimated glomerular filtration rate and obtaining a urinalysis to assess for albuminuria. Renal ultrasonography may also be helpful in determining the cause and chronicity of the renal failure.
Already a member or subscriber? Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier-Saunders; New York, American Psychiatric Pub, Inc. Australian medicines handbook Australian Medicines Handbook Pty Ltd. The American Journal of Medicine. Annals of Internal Medicine. Journal of Hypertension Supplement. Annals of the New York Academy of Sciences.
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Carotid artery stenosis Renal artery stenosis. Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon. Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia. Cherry hemangioma Halo nevus Spider angioma. Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer.
Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension. Retrieved from " https: Uses authors parameter Infobox medical condition new Use dmy dates from September Views Read Edit View history. Renal artery stenosis and renal parenchymal disease Hypertension due to renal causes can be categorised as resulting from renovascular causes and renal parenchymal disease.
Obstructive sleep apnoea OSA is a sleep-related breathing disorder characterised by episodes of complete or partial upper airway obstruction occurring during sleep, resulting in repetitive oxygen desaturation and sleep fragmentation. Failure to recognise secondary causes can lead to resistant hypertension, cardiovascular complications or complications of the underlying condition.
Screening tests, if available, should be performed to detect these conditions. Diagnosis and treatment of causes of secondary hypertension can lead to good clinical outcomes. Click here to view. Ministry of Health Singapore.
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Hypertension: Secondary Hypertension
In about 10% of people, high blood pressure is caused by another disease. If that is the case, it is called secondary hypertension. In such cases. By contrast, patients who have clinical clues suggesting the possible presence of secondary hypertension should undergo a more extensive. Secondary hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. It is much less common than the.