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Diagnosing secondary hypertension
1Clinton Memorial Hospital, Wilmington, Ohio 45177, USA. edonusko@cmhregional.com
Insights
Secondary hypertension, caused by identifiable conditions, accounts for 5-10% of high blood pressure cases. The ABCDE mnemonic aids in diagnosing these underlying causes, which are often treatable.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Secondary hypertension, characterized by elevated blood pressure from an identifiable cause, represents a small but significant percentage (5-10%) of all hypertension cases.
- Identifying and treating the underlying cause of secondary hypertension is crucial as these conditions are often correctable.
Purpose of the Study:
- To present an overview of secondary hypertension and its common causes.
- To introduce the ABCDE mnemonic as a tool for screening secondary causes of hypertension.
- To recommend initial diagnostic tests for patients with hypertension.
Main Methods:
- Literature review of secondary hypertension causes.
- Explanation of the ABCDE mnemonic (Accuracy, Apnea, Aldosteronism, Bruits, Bad kidneys, Catecholamines, Coarctation, Cushing's, Drugs, Diet, Erythropoietin, Endocrine disorders).
- Outline of a general screening algorithm for secondary hypertension.
- Recommendation of routine laboratory tests and electrocardiogram.
Main Results:
- Secondary hypertension arises from diverse underlying conditions, including obstructive sleep apnea, aldosteronism, renal artery stenosis, renal parenchymal disease, endocrine disorders, and certain medications or dietary factors.
- The ABCDE mnemonic provides a structured approach to systematically evaluate potential secondary causes.
- Initial recommended investigations include urinalysis, complete blood count, comprehensive metabolic panel, and a 12-lead electrocardiogram.
Conclusions:
- Secondary hypertension, though less common, requires thorough investigation due to its potentially correctable nature.
- The ABCDE mnemonic serves as a valuable clinical aid for identifying secondary causes of hypertension.
- Standard initial workup for hypertensive patients should include basic laboratory tests and an electrocardiogram to screen for potential underlying etiologies.
Abstract:
Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Only about 5 to 10 percent of hypertension cases are thought to result from secondary causes. The ABCDE mnemonic can be used to help determine a secondary cause of hypertension: Accuracy of diagnosis, obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, excess Erythropoietin, and Endocrine disorders. An algorithm showing the general strategy to help screen for factors involved in secondary hypertension is presented. Routine urinalysis, complete blood cell count, blood chemistry profile (potassium, sodium, creatinine, fasting glucose, fasting lipid levels), and a 12-lead electrocardiogram are recommended for all patients with hypertension.