Secondary Hypertension: Discovering the Underlying Cause.

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.