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Secondary hypertension: evaluation and treatment
B E Akpunonu1, P J Mulrow, E A Hoffman
1Medical College of Ohio Toledo, USA.
Disease-A-Month : DM
|October 1, 1996
Summary
Secondary hypertension, a rare but treatable form of high blood pressure, requires careful evaluation. Identifying specific causes through clinical clues and tests is crucial for effective management and potential cure.
Area of Science:
- Internal Medicine
- Cardiology
- Nephrology
- Endocrinology
- Radiology
Background:
- Essential (primary) hypertension, with unknown causes, affects 95% of US patients.
- Secondary hypertension, accounting for 5% of cases, has identifiable and treatable causes.
- This form is considered 'curable' or 'treatable' by physicians, emphasizing the importance of diagnosis.
Purpose of the Study:
- To outline the diagnostic approach to secondary hypertension.
- To highlight clinical features suggestive of secondary hypertension.
- To emphasize the multidisciplinary nature of evaluating and treating secondary hypertension.
Main Methods:
- Review of clinical features aiding diagnosis: age of onset, severity, end-organ damage, body habitus, physical findings.
- Identification of specific biochemical tests indicative of underlying disorders (e.g., hypercalcemia, hyperglycemia, hypokalemia).
- Correlation of physical examination findings (e.g., abdominal bruits, decreased femoral pulses) with potential causes.
Main Results:
- Specific patient characteristics can strongly suggest secondary hypertension.
- Age extremes (onset <20 or >50 years) and refractory hypertension are key indicators.
- Biochemical and physical findings provide crucial clues to specific etiologies like renovascular disease, endocrine disorders, or coarctation of the aorta.
Conclusions:
- A thorough history, physical examination, and targeted investigations are essential for diagnosing secondary hypertension.
- Early identification of secondary causes allows for specific medical or surgical interventions, potentially leading to cure.
- While not all hypertensive patients require extensive workup, recognizing suggestive features is vital for optimal patient care.
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