Everything about Secondary Hypertension totally explained

| ICD9 = | }} While most forms of hypertension in humans have no known underlying cause (and are thus known as "essential hypertension" or "primary hypertension"), in about 10% of the cases, there's a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension).

Types

Renovascular hypertension (I15.0)

See main article at Renovascular hypertension.

Hypertension secondary to other renal disorders (I15.1)

Chronic renal failure

Kidney disease / renal artery stenosis: the normal physiological response to low blood pressure in the renal arteries is to increase cardiac output (CO) to maintain the pressure needed for glomerular filtration. Here, however, increased CO can't solve the structural problems causing renal artery hypotension, with the result that CO remains chronically elevated.

Renal segmental hypoplasia (Ask-Upmark kidney)

Hypertension secondary to endocrine disorders (I15.2)

Pheochromocytoma

Hyperaldosteronism (Conn's syndrome)

Hypothyroidism

Other secondary hypertension (I15.8)

Obstructive sleep apnea

Liquorice (when consumed in excessive amounts)

Scleroderma

Neurofibromatosis

Pregnancy: unclear etiology.

Cancers: tumours in the kidney can operate in the same way as kidney disease. More commonly, however, tumors cause inessential hypertension by ectopic secretion of hormones involved in normal physiological control of blood pressure.

Drugs: In particular, alcohol, nasal decongestants with adrenergic effects, NSAIDs, MAOIs, adrenoceptor stimulants, and combined methods of hormonal contraception (those containing ethinyl-estradiol) can cause hypertension while in use.

Heavy alcohol use
Steroid use

Malformed aorta, slow pulse: these cause reduced blood flow to the renal arteries, with physiological responses as already outlined.

Aortic valve disease: unclear etiology.
Coarcation of the aorta

Anemia: unclear etiology.

Fever: unclear etiology.

Diagnosis

The ABCDE mnemonic can be used to help determine a secondary cause of hypertension

A: Accuracy, Apnea, Aldosteronism

B: Bruits, Bad Kidney

C: Catecholamines, Coarctation of the Aorta, Cushing's Syndrome

D: Drugs, Diet

E: Erythropoietin, Endocrine Disorders

Laboratory Tests

Urinalysis

Complete blood count

Blood chemistries (potassium, sodium, creatinine, fasting glucose)

Fasting lipid profile (LDL, HDL, triglycerides, total cholesterol)

12-lead electrocardiogram

ABPM (ambulatory blood pressure monitoring) (in the routine evaluation and management of children with hypertension) Children with secondary hypertension were found to have significantly higher diastolic BP loads during both the daytime and nocturnal portions of the ABPM studies and also a significantly greater nocturnal systolic BP load, compared with children with primary hypertension.

Goals

The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) defines four goals for the evaluation of the patient with elevated blood pressure:

detection and confirmation of hypertension;

detection of target organ disease (for example, renal damage, congestive heart failure);

identification of other risk factors for cardiovascular disorders (for example, diabetes mellitus, hyperlipidemia);

detection of secondary causes of hypertension.

Further Information

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