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Secondary Hypertension: Discovering the Underlying Cause

Lesley Charles1, Jean Triscott1, Bonnie Dobbs1

  • 1University of Alberta, Edmonton, Alberta, Canada.

American Family Physician
|November 3, 2017
PubMed

Insights

Secondary hypertension, a potentially reversible cause of high blood pressure, affects 5-10% of patients. Identifying its underlying cause is crucial, as etiologies vary significantly by age group.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiology

Background:

  • Primary hypertension lacks a clear cause in most patients.
  • Secondary hypertension, caused by an underlying condition, is present in 5-10% of hypertensive individuals.
  • Etiologies of secondary hypertension differ across age groups.

Purpose of the Study:

  • To review the prevalence and etiologies of secondary hypertension.
  • To highlight clinical indicators for considering secondary hypertension.
  • To discuss specific diagnostic considerations for renovascular hypertension.

Main Methods:

  • Literature review of secondary hypertension prevalence and causes.
  • Analysis of age-specific etiologies in pediatric and adult populations.
  • Identification of clinical signs and symptoms suggestive of secondary hypertension.

Main Results:

  • Common causes in children include renal parenchymal disease and coarctation of the aorta.
  • In adults over 65, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are frequent causes.
  • Specific criteria for suspecting renovascular hypertension include rapid creatinine increase with ACE inhibitors/ARBs, severe hypertension with kidney size discrepancies, or recurrent pulmonary edema.

Conclusions:

  • Secondary hypertension should be suspected in patients with specific clinical presentations, including early-onset, resistant, or malignant hypertension.
  • Renovascular hypertension has distinct diagnostic clues.
  • Other significant causes include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, and medication use.

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