Materiały źródłowe

• #1 Secondary Hypertension: Discovering the Underlying Cause | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p453.html

  Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. […] Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications. […] Secondary hypertension is a type of hypertension with an underlying and potentially reversible cause. It makes up only a small fraction (5% to 10%) of hypertensive cases.

• #2 Secondary Hypertension: Discovering the Underlying Cause – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29094913/

  Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. […] Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.

• #3 Secondary Hypertension: Discovering the Underlying Cause | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p453.html

  Likely etiologies of secondary hypertension are different in children compared with adults. A summary of the most common causes of secondary hypertension by age is provided. Across all adult ages, renovascular hypertension, renal disease, aldosteronism, and obstructive sleep apnea (OSA) represent the most common causes of secondary hypertension. […] Renovascular hypertension is a common, potentially reversible cause of secondary hypertension. […] Secondary hypertension in these cases is suggested by an elevated serum creatinine level or proteinuria on urinalysis. Renal parenchymal disease is the most common cause of hypertension in preadolescent children. […] Once thought to be rare, primary hyperaldosteronism is now considered one of the more common causes of secondary hypertension.

• #4 Secondary hypertension – Knowledge and References – Taylor & Francis

  https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Endocrinology/Secondary_hypertension/

  Secondary hypertension is hypertension due to an identifiable cause, which may be treatable with an intervention specific to the cause. A high index of suspicion and early detection of secondary causes of hypertension are important because interventions may be curative, especially in younger patients. […] Secondary hypertension is elevated blood pressure that is caused by some identifiable factor. Secondary hypertension likely accounts for less than 10% of all cases of hypertension. Unlike primary hypertension, which requires life-long management, forms of secondary hypertension may be potentially cured if the causative factor is identified and removed. […] Secondary hypertension should be suspected if there is new onset or uncontrolled hypertension in adults. Screen for secondary hypertension if there is drug-resistant/induced hypertension, abrupt onset of hypertension, onset of hypertension in a person younger than 30 years, exacerbation of previously controlled hypertension, disproportionate target organ damage for the degree of hypertension, accelerated/malignant hypertension, onset of diastolic hypertension in elderly persons, or unprovoked or excessive hypokalemia. Common causes of secondary hypertension include renal parenchymal disease, renovascular disease, primary aldosteronism, obstructive sleep apnea, and drug-or alcohol-induced hypertension. Uncommon causes of secondary hypertension include pheochromocytoma/paraganglioma, Cushing’s syndrome, hypothyroidism, hyperthyroidism, aortic coarctation, primary hyperparathyroidism, congenital adrenal hyperplasia, mineralocorticoid excess syndromes, and acromegaly.

• #5 Secondary Hypertension: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/21128-secondary-hypertension

  Secondary hypertension is high blood pressure with an identifiable cause. Often, the cause is a medical condition or a medication you’re taking. […] Secondary hypertension is high blood pressure that has a known cause. The cause might be another medical condition, or certain medicines or substances you’re using. Often, treating this underlying cause can reduce your blood pressure to healthier levels. […] The causes of secondary hypertension (from most to least common) include: Obstructive sleep apnea, Renal artery stenosis, Primary aldosteronism (Conns syndrome), Medications, alcohol or other substances, Renal parenchymal disease, Tumors (pheochromocytoma and paraganglioma), Cushing syndrome, Underactive thyroid (hypothyroidism), Overactive thyroid (hyperthyroidism), Coarctation of the aorta.

• #6 Secondary Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544305/

  Secondary hypertension is defined as elevated blood pressure (BP) secondary to an identifiable cause. […] Myriads of etiologies have been reported for secondary hypertension, which may be classified into the following broad categories; […] The renal parenchymal disease is the most common cause of secondary hypertension. […] Hypertension due to endocrine disorders is caused by increased secretion of hormones. […] Hypertension due to renovascular disorders is a rare entity and occurs due to stenosis of the unilateral or bilateral renal arteries. […] Coarctation of the aorta is the prime example of vascular disorders resulting in secondary hypertension in young adults. […] Obstructive sleep apnea, polycystic ovarian syndrome, preeclampsia, and drugs may contribute to the etiology of secondary hypertension.

• #7 Secondary hypertension: What is secondary high blood pressure?

  https://www.medicalnewstoday.com/articles/secondary-hypertension

  Kidney disease is the most common cause of secondary hypertension. Other causes include hormonal imbalances, cardiovascular disorders, and the use of certain medications. […] Secondary hypertension is high blood pressure that results from an underlying condition, such as kidney disease. Like primary hypertension, it may have no symptoms but can be life threatening without treatment.

• #8

  https://healthmatch.io/high-blood-pressure/what-is-secondary-hypertension

  The causes of secondary hypertension vary depending on age. Since secondary hypertension only happens when there is an underlying condition, it has many causes. […] Renal parenchymal disease damages the functional part of the kidney, the parenchyma. Its the most common cause of secondary hypertension, accounting for 2.5% to 5% of all cases, mostly affecting children. […] Fibromuscular dysplasia involving renal arteries often leads to secondary hypertension. […] Hyperaldosteronism features elevated levels of aldosterone secretion by the adrenal glands. This leads to your kidneys retaining high levels of sodium and water, causing an increase in blood pressure. Hyperaldosteronism is the most common cause of drug-resistant hypertension. […] Obstructive sleep apnea causes hypertension due to hypoxia (lack of oxygen) during sleep. This leads to blood vessel damage, increasing resistance, and causing diastolic and systolic blood pressure surges at night. […] Secondary hypertension is less common, and its rarity makes it difficult to diagnose the condition without in-depth investigations. In some cases, your condition could become more severe before you receive a diagnosis.

• #9 Secondary Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544305/

  Drug-induced hypertension is a significant cause of secondary hypertension. […] The prevalence of secondary hypertension varies with age and it is most prevalent at the extremes of age. […] Renal parenchymal diseases are responsible for secondary hypertension in 3-5% of the people diagnosed with hypertension. […] Primary aldosteronism is the main endocrine disorder leading to secondary hypertension and is found in as high as 5% of patients with hypertension. […] Secondary hypertension shares these complications with essential hypertension, however, a few complications are much more common in secondary hypertension.

• #10 Hypertension: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/241381-overview

  Renovascular hypertension (RVHT) causes 0.2-4% of cases of hypertension. Since the 1934 seminal experiment by Goldblatt et al, RVHT has become increasingly recognized as an important cause of clinically atypical hypertension and chronic kidney disease the latter by virtue of renal ischemia. […] Endocrine causes may account for the largest proportion of secondary hypertension (10-20%) and include exogenous or endogenous hormonal imbalances. Exogenous causes include administration of steroids. Primary hyperaldosteronism is the most common endogenous hormone abnormality causing hypertension. […] Another common endocrine cause of hypertension is oral contraceptive use, likely due to activation of the renin-angiotensin-aldosterone system (RAAS). This is caused by increased hepatic synthesis of angiotensinogen in response to the estrogen component of oral contraceptives.

• #11 Chapter 12. Secondary hypertension | Hypertension Research

  https://www.nature.com/articles/hr200813

  Renovascular hypertension is hypertension caused by stenosis or obstruction of the renal artery and is observed in about 1% of hypertensive patients. Its etiological mechanism is the activation of the RA system by a reduction in the renal perfusion pressure. […] Endocrine hypertension is a group of diseases in which hypertension is caused by excessive hormone secretion due to a tumor or hyperplasia of the endocrine organs. PA, Cushing’s syndrome and pheochromocytoma are the major causes of endocrine hypertension.

• #12 Understanding secondary hypertension – Harvard Health

  https://www.health.harvard.edu/heart-health/understanding-secondary-hypertension

  High blood pressure (hypertension) usually results from a combination of factors, including age, genetics, obesity, a high-salt diet, and lack of exercise. But up to 10% of people with high blood pressure have secondary hypertension, which is a byproduct of another condition or disease. […] Most cases of secondary hypertension involve problems with the adrenal glands or the renal arteries. […] The most common cause of secondary hypertension is hyperaldosteronism, in which one or both adrenal glands make too much aldosterone. […] Renal artery stenosis, a narrowing of the arteries that supply the kidneys with blood, is another common cause of secondary hypertension. […] Less-common causes of secondary hypertension include Cushing’s syndrome (which results from over-production of the stress hormone cortisol by the adrenal glands or from long-term use of steroid drugs) and thyroid disorders (diseases or growths that affect the thyroid gland’s production of its hormone). […] Secondary hypertension is common among people with so-called resistant hypertension, which includes people in the fourth group, as well as people who take three different blood pressure drugs at their maximum tolerated doses but still have high blood pressure.

• #13 Ruling out secondary causes of hypertension | EuroIntervention

  https://eurointervention.pcronline.com/article/ruling-out-secondary-causes-of-hypertension

  The prevalence of primary aldosteronism (PA) is greater than previously thought. […] It is thought that hypokalaemia is only present in severe and/or late manifestations of PA. […] Among untreated patients, the prevalence of PA increases in parallel with the increasing severity of the hypertension, from 2% in patients with stage 1 hypertension to 8% in those with stage 2 hypertension and 13% in those with stage 3 hypertension. […] Moreover, in resistant hypertensives, the prevalence of PA ranges between 15 and 23%. […] Drug-induced hypertension is one of the most common causes of secondary hypertension and is often found in clinical practice. […] Many prescriptions and over-the-counter medicines can exacerbate arterial hypertension. […] There are a number of rare causes of secondary hypertension, which cannot be discussed in detail in this article.

• #14 Secondary Hypertension: Discovering the Underlying Cause | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1001/p453.html

  OSA is a leading treatable cause of secondary hypertension. […] Pheochromocytoma should be suspected when there are paroxysmal elevations in blood pressure. […] Cushing syndrome has classical features of moon facies, central obesity, proximal muscle weakness, and ecchymosis. […] Coarctation of the aorta is a common cause of secondary hypertension in children, especially males, but may not be detected until adulthood because it is often asymptomatic. […] Hypothyroidism can cause an elevation in diastolic blood pressure, whereas hyperthyroidism can cause an elevation of systolic blood pressure, leading to a widened pulse pressure. […] Several chemotherapeutic agents can cause secondary hypertension and kidney injury. […] Oral contraceptives can raise blood pressure within the normal range but can also cause secondary hypertension.

• #15 Secondary hypertension – Etiopathogenesis, Clinical features, Advances in Management | PPT

  https://www.slideshare.net/drchetankg/secondary-hypertension-etiopathogenesis-clinical-features-advances-in-management

  Renovascular hypertension develops from partial obstruction of one main renal artery. Causes include atherosclerotic fibromuscular dysplasia, renal vasculitis, coarctation of the aorta with renal ischemia, aortitis with renal ischemia, cholesterol emboli, and compression of this vessel by nearby tumors. […] Primary aldosteronism is a very uncommon cause. However, in studies systematically screening all patients with hypertension, prevalence varies from 5% to 12% of hypertensive individuals. Prevalence is higher in patients with hypokalemic hypertension. […] Pheochromocytoma are catecholamine-producing tumors derived from the sympathetic or parasympathetic nervous system. Incidence is 28 / 1 million per year. 0.1% of hypertensive patients harbor a pheochromocytoma. […] Coarctation of the aorta is the most common congenital cardiovascular cause of hypertension. Incidence is 18 per 1000 live births. It is usually sporadic but occurs in 35% of children with Turner’s syndrome.

• #16 Secondary Hypertension – Harvard Health

  https://www.health.harvard.edu/a_to_z/secondary-hypertension-a-to-z

  Most people with high blood pressure are diagnosed with primary hypertension. Currently this means that no specific cause is identified for the condition. Some of the time, however, high blood pressure is caused by another condition or disease. When this happens, it is called secondary hypertension. […] Some of the medical problems that can cause secondary hypertension include: […] Kidney disease. Secondary hypertension can be related to damaged kidneys or to an abnormal narrowing of one or both renal arteries. […] Hyperparathyroidism. A hormone called parathormone is made by four tiny glands in the neck called parathyroid glands. If the glands produce too much hormone, calcium levels in the blood increase. People with hyperparathyroidism are more likely to have high blood pressure. […] Adrenal disease. The adrenal glands sit on top of the kidneys and produce several hormones that help regulate blood pressure. Sometimes, one or both adrenal glands make and secrete an excess of one of these hormones.

• #17 Chapter 13. Secondary hypertension | Hypertension Research

  https://www.nature.com/articles/hr201416

  Hypertension related to a specific etiology is termed secondary hypertension, markedly differing from essential hypertension, of which the etiology cannot be identified, in the condition and therapeutic strategies. […] Frequent etiological factors for secondary hypertension include renal parenchymal hypertension, primary aldosteronism (PA), renovascular hypertension and sleep apnea syndrome. […] In patients with PA, an excessive production of aldosterone in the adrenal glands is involved in the pathogenesis of hypertension. […] Concerning renovascular hypertension, renal artery stenosis-related hyperactivity of the renin-angiotensin (RA) system contributes to an increase in blood pressure. […] As other etiological factors for secondary hypertension, the following conditions have been reported: in endocrine hypertension, pheochromocytoma and Cushing’s syndrome are related to an excessive production of catecholamines and cortisol, respectively.

• #18 Secondary hypertension – Wikipedia

  https://en.wikipedia.org/wiki/Secondary_hypertension

  Secondary hypertension (or, less commonly, inessential hypertension) is a type of hypertension which has a specific and identifiable underlying primary cause. It has many different causes including obstructive sleep apnea, kidney disease, endocrine diseases, and tumors. The cause of secondary hypertension varies significantly with age. […] The cause of secondary hypertension are numerous (obstructive sleep apnea, kidney disease, endocrine diseases, tumors, medication side effect, Etc.) and etiologies varies significantly with age. […] Obstructive sleep apnea (OSA) is one of the most common causes; 30-50% of patients who have OSA have co-morbid secondary hypertension. […] There are two main causes of renovascular hypertension: renal artery stenosis and fibromuscular dysplasia. […] Hypertension is common in chronic kidney disease.

• #19 Secondary Arterial Hypertension: When, Who, and How to Screen?

  https://www.acc.org/latest-in-cardiology/journal-scans/2014/01/10/15/45/secondary-arterial-hypertension-when-who-and-how-to-screen

  Secondary hypertension (defined as hypertension due to an identifiable cause) affects only 5-10% of hypertensive patients. […] The following are characteristics suggestive of secondary hypertension: early onset of hypertension (180/110 mm Hg), sudden increase of blood pressure (BP) in a previously stable patient, nondipping or reverse dipping during 24-hour ambulatory BP monitoring (ABPM), and presence of target organ damage. […] Obstructive sleep apnea is one of the most common causes of secondary hypertension. Nocturnal hypoxemia may impact the renin-angiotensin-aldosterone system and increase sympathetic nerve activity. […] Primary aldosteronism may be suggested by hypokalemia (albeit only in 40% of patients), resistant hypertension, muscle weakness, constipation, and fatigue. […] Even after identification and treatment of a secondary cause of hypertension, BP may not return to normal. This is likely secondary to concomitant essential hypertension and/or vascular remodeling that has occurred over time.

• #20 Drug-induced causes of secondary hypertension

  https://atm.amegroups.org/article/view/15358/html

  Resistant hypertension is a blood pressure that remains above the treatment goal despite use of optimal doses of three antihypertensive drugs of different classes including a diuretic (1). Patients with resistant hypertension should be screened for causes of secondary hypertension (2). Common causes of secondary hypertension include renal parenchymal disease (1), renovascular disease (3), dug-induced causes (4), pregnancy (5), primary aldosteronism (6), and obstructive sleep apnea (7). […] Because of their widespread use, nonsteroidal anti-inflammatory drugs, aspirin, and acetaminophen are the commonest drugs in worsening control of blood pressure (1). Blood pressure is increased by both cyclooxygenase 1-inhibitors and by cyclooxygenase 2-inhibitors. Nonsteroidal anti-inflammatory drugs increase blood pressure by influencing prostaglandin production causing adverse renal effects (9). Nonsteroidal anti-inflammatory drugs also increase systemic vascular resistance by increased endothelin-1 synthesis and by altered arachidonic metabolism (9).

• #21 Drug-induced causes of secondary hypertension

  https://atm.amegroups.org/article/view/15358/html

  Amphetamine, methylphenidate dexmethylphenidate, and dextroamphetamine used to treat attention-deficit/hyperactivity disorder in children and adolescents may cause an elevated blood pressure (14). […] Systemic corticosteroids such as dexamethasone, fludrocortisone, methylprednisolone, prednisone, and prednisolone may cause an elevated blood pressure (4). The increase in blood pressure is dose dependent. […] Estrogens, androgens, and oral contraceptives may cause an increase in blood pressure (2,4,9). Oral contraceptives should not be used in women with uncontrolled hypertension (4). […] Immunosuppressants may cause an increase in blood pressure (2,4,9,17,18). […] Chronic use of recombinant human erythropoietin may cause hypertension (19). Mechanisms for the erythropoietin-induced hypertension include increase in hematocrit and erythrocyte mass, increased sensitivity to endogenous vasopressors, dysregulation of production or responsiveness to endogenous vasodilatory factors, a direct vasopressor effect, and stimulation of vascular cell growth (19).

• #22 Hypertension: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/241381-overview

  Neurogenic causes include the following: Brain tumor, Autonomic dysfunction, Sleep apnea, Intracranial hypertension. […] Drugs and toxins that cause hypertension include the following: Alcohol, Cocaine, Cyclosporine, tacrolimus, NSAIDs, Erythropoietin, Adrenergic medications, Decongestants containing ephedrine, Herbal remedies and candy that contain licorice (including licorice root) or ephedrine (and ephedra), Nicotine. […] Other causes include the following: Hyperthyroidism and hypothyroidism, Hypercalcemia, Hyperparathyroidism, Acromegaly, Obstructive sleep apnea, Pregnancy.

• #23 Secondary Causes of Hypertension | KnowledgeDose

  https://www.knowledgedose.com/secondary-causes-of-hypertension/

  Other diseases/conditions/causes: obstructive sleep apnoea, pregnancy, scleroderma, systemic lupus erythematosus (SLE), polyarteritis nodosa, retroperitoneal fibrosis. […] In addition to the above diseases and conditions that can cause secondary hypertension, there are some drugs that can cause secondary hypertension too. […] Drugs causing hypertension (drug-induced hypertension): alcohol, caffeine, herbal supplements e.g. ginseng, liquorice, St Johns wort, ephedra (ma huang), yohimbine, illicit drugs e.g. cocaine, ecstasy, methamphetamine, oral contraceptives, hormone replacement therapy (HRT), oestrogens, androgens, corticosteroids e.g. dexamethasone, fludrocortisone, hydrocortisone, methylprednisolone, prednisolone, immunosuppressants e.g. ciclosporin, anti-vascular endothelial growth factor (anti-VEGF) drugs e.g. bevacizumab, tyrosine kinase inhibitors (TKIs) e.g. sunitinib, sorafenib, ketoconazole, erythropoietin, leflunomide, non-steroidal anti-inflammatory drugs, sympathomimetics e.g. phenylephrine, pseudoephedrine, ephedrine, drugs used for attention deficit hyperactivity disorder (ADHD) e.g. methylphenidate, atomoxetine, dexamfetamine, lisdexamfetamine, atypical antipsychotics e.g. clozapine, olanzapine, tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors (SNRIs) e.g. venlafaxine, monoamine-oxidase inhibitors (MAOIs) e.g. phenelzine, tranylcypromine.

• #24 Secondary Hypertension: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/21128-secondary-hypertension

  Medications that can raise your blood pressure include: Amphetamines, Angiogenesis inhibitors, like bevacizumab, that treat cancer, Antidepressants, Corticosteroids (systemic), like prednisone and methylprednisolone, Decongestants, Immunosuppressants, Oral contraceptives, NSAIDs, Second-generation (atypical) antipsychotics. […] Other substances that can cause secondary hypertension include: Alcohol, Herbal supplements, Nicotine, Recreational drugs. […] Untreated, secondary hypertension can lead to hypertensive heart disease. This is damage to your heart that results from years of high blood pressure. […] Secondary hypertension may be your provider’s first clue that you have another condition. Getting help for secondary hypertension may be the first step toward managing the underlying condition.

• #25 Hypertension: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/241381-overview

  Hypertension can be primary, which may develop as a result of environmental or genetic causes, or secondary, which has multiple etiologies, including renal, vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of adult cases, and a small percentage of patients (2-10%) have a secondary cause. Hypertensive emergencies are most often precipitated by inadequate medication or poor adherence. […] Secondary causes of hypertension related to single genes are very rare. They include Liddle syndrome, glucocorticoid-remediable hyperaldosteronism, 11 beta-hydroxylase and 17 alpha-hydroxylase deficiencies, syndrome of apparent mineralocorticoid excess, and pseudohypoaldosteronism type II. […] Renal causes (2.5-6%) of hypertension include the renal parenchymal diseases and renal vascular diseases, as follows: Polycystic kidney disease, Chronic kidney disease, Urinary tract obstruction, Renin-producing tumor, Liddle syndrome, Nephritic syndrome/glomerulonephritis.

• #26 Secondary Causes of Hypertension | KnowledgeDose

  https://www.knowledgedose.com/secondary-causes-of-hypertension/

  Secondary hypertension is hypertension due to an identifiable cause, which may be treatable with an intervention specific to the cause; it can be found in approximately 5-10% of patients diagnosed with hypertension. […] Listed below are some of the causes of secondary hypertension. […] Renal causes: renal parenchymal disease: polycystic kidney disease, diabetic nephropathy, obstructive uropathy, glomerulonephritis and chronic pyelonephritis. Renovascular disease: renal artery stenosis and fibromuscular dysplasia. […] Vascular causes: coarctation of the aorta. […] Endocrine causes: Cushing’s syndrome/disease, primary aldosteronism, phaeochromocytoma/paraganglioma, hyperthyroidism, hypothyroidism, hyperparathyroidism, acromegaly. […] Inherited causes: Liddle syndrome, apparent mineralocorticoid excess, Gordon syndrome, Geller syndrome, glucocorticoid-remediable hypertension.

• #27 Secondary hypertension – Etiopathogenesis, Clinical features, Advances in Management | PPT

  https://www.slideshare.net/drchetankg/secondary-hypertension-etiopathogenesis-clinical-features-advances-in-management

  Hypertension during pregnancy appears after 20 weeks in about 12% of first pregnancies in previously normotensive women. In about half of cases, this hypertension will progress to preeclampsia when it is complicated by proteinuria, edema, or hematologic or hepatic abnormalities. […] Monogenic hypertension includes conditions like Liddle’s syndrome and Gordon’s syndrome, characterized by specific genetic defects leading to hypertension.

• #28 Secondary Hypertension – Harvard Health

  https://www.health.harvard.edu/a_to_z/secondary-hypertension-a-to-z

  Three different types of adrenal gland conditions cause high blood pressure: […] Pheochromocytoma. A tumor of the adrenal gland that overproduces the hormones epinephrine (adrenalin) and norepinephrine (noradrenalin). […] Hyperaldosteronism. Large amounts of the salt-retaining hormone aldosterone can be produced by an adrenal tumor in one of the two adrenal glands. […] Hypercortisolism (also called Cushing’s syndrome). Both adrenal glands can over produce the hormone cortisol, or a benign or malignant tumor can make and release too much of the hormone. […] Other rare causes of secondary hypertension include: […] Acromegaly. A pituitary tumor that produces too much growth hormone. […] An adrenocorticotrophic hormone (ACTH) producing tumor of the pituitary gland. The pituitary normally makes a small amount of ACTH daily. Excess ACTH production and secretion causes the adrenal glands to overproduce cortisol, raising blood pressure.

• #29 Diagnosis of Secondary Hypertension: An Age-Based Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1471.html

  Whenever a patient is diagnosed with hypertension, one purpose of the initial assessment (i.e., history, physical examination, and basic laboratory testing) is to exclude possible secondary causes. […] Indications for further investigation into a possible secondary etiology in the absence of suggestive signs and symptoms include resistant hypertension, early or late onset of hypertension, a severe or accelerated course, or specific drug intolerances. […] The most common etiologies in children, in whom 70 to 85 percent of cases of hypertension have a secondary cause, are different from those in older persons; therefore, an age-based approach to the differential diagnosis is recommended. […] Primary aldosteronism, also referred to as hyperaldosteronism, is actually a group of conditions, including aldosterone-producing adenomas and bilateral idiopathic hyperaldosteronism.

• #30 Whom should you test for secondary causes of hypertension? | MDedge

  https://mdedge.com/jfponline/article/79621/pediatrics/whom-should-you-test-secondary-causes-hypertension

  Secondary hypertension is more prevalent in younger children and in children and adolescents with stage 2 hypertension (blood pressure [BP] >99th percentile for age and height plus 5 mm Hg). Renoparenchymal and renovascular disease account for most cases of secondary hypertension in these children. […] The National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents recommends that all children and adolescents with hypertension have an additional diagnostic work-up. This is based on the observation that 70% to 85% of children <12 years and 10% to 15% of adolescents 12 to 18 years with hypertension have an underlying cause, most commonly renoparenchymal and renovascular disease. [...] According to the National Institutes of Health (NIH), “the possibility that some underlying disorder may be the cause of the hypertension should be considered in every child or adolescent” with elevated BP, but the evaluation itself should be individualized.

• #31 What are the common causes of secondary hypertension? | The Faculty of Intensive Care Medicine

  https://www.ficm.ac.uk/documents/what-are-the-common-causes-of-secondary-hypertension

  What are the common causes of secondary hypertension? […] Coarctation of the aorta […] Congenital renal parenchymal disease e.g. Polycystic Kidney Disease […] Genetic syndromes e.g. Liddle syndrome, 11-dehydrogenase deficiency […] Renal artery stenosis secondary to fibromuscular dysplasia (especially women) […] Pre-eclampsia […] Medications e.g. stimulants (amphetamine, cocaine), nasal decongestants (phenylephrine), OCP, diet pills […] Phaeochromocytoma (possibly in conjunction with neurofibromatosis, MEN2a /2b or Von-Hippel Lindau syndrome) […] Obstructive sleep apnoea […] Cushings syndrome […] Atherosclerotic renal artery stenosis […] Acquired renal parenchymal disease e.g. diabetes, glomerulonephritis etc. […] Conns disease (primary hyperaldosteronism) […] Hyperthyroidism.

• #32 Investigating hypertension in younger patients | The BMJ

  https://www.bmj.com/content/376/bmj-2021-067924.abstract

  Secondary hypertension may account for up to 30% of diagnoses of young onset hypertension. […] Thyroid dysfunction, renal parenchymal disease, and renal artery stenosis secondary to fibromuscular dysplasia are the most common causes of secondary hypertension in younger patients. […] Essential hypertension remains the most common cause of hypertension, even in young onset hypertension, but secondary hypertension which has an underlying pathological cause accounts for 5% to 30% of cases of young onset hypertension.

• #33 Diagnosis of Secondary Hypertension: An Age-Based Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1471.html

  Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. A secondary etiology may be suggested by symptoms (e.g., flushing and sweating suggestive of pheochromocytoma), examination findings (e.g., a renal bruit suggestive of renal artery stenosis), or laboratory abnormalities (e.g., hypokalemia suggestive of aldosteronism). […] Approximately 5 to 10 percent of adults with hypertension have a secondary cause. In young adults, particularly women, renal artery stenosis caused by fibromuscular dysplasia is one of the most common secondary etiologies. […] In middle-aged adults, aldosteronism is the most common secondary cause of hypertension, and the recommended initial diagnostic test is an aldosterone/renin ratio. […] Up to 85 percent of children with hypertension have an identifiable cause, most often renal parenchymal disease.

• #34

  https://healthmatch.io/high-blood-pressure/what-is-secondary-hypertension

  Secondary hypertension is high blood pressure caused by another underlying condition affecting your kidneys, heart, arteries, or endocrine system. Because its a rare condition, the underlying causes arent always clear and may require more in-depth investigations to discover. […] The prevalence and causes of secondary hypertension vary by age. It accounts for many hypertensive cases among children and young people. Causes include: Renal parenchymal disease in children, Renal artery stenosis caused by fibromuscular dysplasia in young women, Renal failure and atherosclerotic renal artery stenosis in adults 65 or older. […] Secondary hypertension can occur during pregnancy. Most commonly, renovascular disease, Cushings syndrome, and pheochromocytoma cause secondary hypertension in pregnancy. This hypertension could develop further into preeclampsia.

• #35 Diagnosis of Secondary Hypertension: An Age-Based Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1471.html

  Obstructive sleep apnea is a notable cause of secondary hypertension, particularly in 40- to 59-year-olds, but less so in those 60 years and older. […] Pheochromocytomas are rare tumors responsible for approximately 0.5 percent of cases of secondary hypertension. […] Renal artery stenosis secondary to atherosclerotic disease affects older adults.

• #36 Secondary hypertension in adults | SMJ

  http://www.smj.org.sg/article/secondary-hypertension-adults

  OSA has been strongly associated with hypertension in large cross-sectional and longitudinal studies. […] Since many patients with OSA remain undiagnosed, a high index of clinical suspicion is needed, particularly in patients with drug-resistant hypertension. […] Secondary hypertension is a common cause of hypertension in adults, occurring in about 10% of hypertensive patients. […] Failure to recognise secondary causes can lead to resistant hypertension, cardiovascular complications or complications of the underlying condition. […] In younger adults ( 30 years of age), renal causes such as glomerulonephritis and coarctation of the aorta should be considered. […] In older adults, primary aldosteronism, RAS and OSA are common and often underdiagnosed.

• #37 Chapter 12. Secondary hypertension | Hypertension Research

  https://www.nature.com/articles/hr200813

  Although the frequency of secondary hypertension varies among populations, it has been reported to be approximately 5% in the general population. However, it is 50% or higher in young patients with severe hypertension. Renal hypertension is considered to be the most frequent form of secondary hypertension, but PA has been reported to be more prevalent than previously considered, and accounts for 310% of all hypertensive patients. […] Screening for secondary hypertension involves a close evaluation of history, physical examinations, and blood and urine tests. The possibility of secondary hypertension is higher in hypertension with an early onset, severe hypertension and resistant hypertension. […] Renal parenchymal hypertension, caused by renal parenchymal disorders, is a common form of secondary hypertension, accounting for 25% of all hypertension.

• #38 CV Physiology | Secondary Hypertension

  https://cvphysiology.com/blood-pressure/bp023

  Secondary hypertension accounts for approximately 5-10% of all cases of hypertension, with the remaining being primary hypertension. Secondary hypertension has an identifiable cause, whereas primary hypertension has no known cause (idiopathic). […] There are many known conditions that can cause secondary hypertension. […] Some causes for secondary hypertension are listed below: Renal artery stenosis, Chronic renal disease, Primary hyperaldosteronism, Stress, Sleep apnea, Hyper- or hypothyroidism, Pheochromocytoma, Preeclampsia, Aortic coarctation. […] Renovascular hypertensionRenal artery disease can cause narrowing of the vessel lumen (stenosis). […] Pathologic processes (e.g., diabetic nephropathy, glomerulonephritis) can damage nephrons in the kidney. […] Increased circulating aldosterone causes renal retention of sodium and water, which causes blood volume and arterial pressure to increase.

• #39 CV Physiology | Secondary Hypertension

  https://cvphysiology.com/blood-pressure/bp023

  Emotional stress leads to activation of the sympathetic nervous system, which causes increased release of norepinephrine from sympathetic nerves in the heart and blood vessels, leading to increased cardiac output and increased systemic vascular resistance. […] Sleep apnea is a disorder in which people repeatedly cease breathing for short periods of time during their sleep. […] Both hyperthyroidism and hypothyroidism can lead to hypertension in some patients, although the mechanisms are poorly understood. […] Catecholamine secreting tumors in the adrenal medulla can lead to very high levels of circulating catecholamines. […] This is a serious condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume. […] Coarctation (narrowing) of the aorta is a congenital defect that most commonly is found just distal to the left subclavian artery in the aortic arch.

• #40 The ABCDEFs of Secondary Hypertension | Time of Care

  https://www.timeofcare.com/the-abcdes-of-secondary-hypertension/

  Circulatory system problems: coarctation of the aorta, renal artery stenosis, and renal disease (glomerular disease renal parenchymal disease). […] Endocrine disorders […] Other causes: Pregnancy, Obesity, Polycystic kidney disease […] The causes of secondary HTN can be divided into: Things from the outside we do to ourselves: Drugs (steroids, etc), poor diet with high salt. […] Endocrine problems: The endocrine hormones exert effects on the blood vessels that raise the blood pressure. […] OSA mechanism from Mayo website: Sleep apnea. In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing you to not get enough oxygen. […] Not getting enough oxygen may damage the lining of the blood vessel walls, which may make your blood vessels less effective in regulating your blood pressure. In addition, sleep apnea causes part of the nervous system to be overactive and release certain chemicals that increase blood pressure.

• #41 Secondary hypertension in adults | SMJ

  http://www.smj.org.sg/article/secondary-hypertension-adults

  Secondary hypertension occurs in a significant proportion of adult patients (~10%). […] In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. […] In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. […] About 10% of patients with hypertension have a secondary cause. […] However, it is important to realise that secondary causes are also common in older patients, particularly primary aldosteronism, renal disease and obstructive sleep apnoea (OSA). […] The prevalence of these conditions is even higher in patients with resistant hypertension, defined as blood pressure (BP) 140/90 mmHg despite the use of three antihypertensive medications, including a diuretic.

• #42 Outpatient Evaluation of Secondary Causes of Resistant Hypertension | ECR Journal

  https://www.ecrjournal.com/articles/outpatient-evaluation-secondary-causes-resistant-hypertension-0?language_content_entity=en

  Primary aldosteronism, pheochromocytoma and renovascular hypertension are hypertensive syndromes often associated with resistant hypertension. […] Distinct hypertensive syndromes causing drug-resistant hypertension are increasingly being recognised. […] Primary aldosteronism is the most common form of secondary hypertension and is often associated with drug-resistant hypertension. […] PHEO is a rare cause of hypertension but its diagnosis is important. […] Renovascular hypertension (RVHT) is due to decreased perfusion from renal artery stenosis (RAS), which results in activation of neurohormonal systems. […] The prevalence of RAS depends on the population that is being screened. […] Of the secondary causes of hypertension, primary aldosteronism, PHEO and RVHT are the hypertensive syndromes most commonly encountered in clinics.

• #43 Secondary hypertension in adults | SMJ

  http://www.smj.org.sg/article/secondary-hypertension-adults

  Important clues suggesting an underlying secondary cause are (a) young patient 30 years of age (renal causes or coarctation of the aorta); (b) symptoms or signs suggesting secondary causes; (c) indication of severe (BP 180/110 mmHg) or resistant hypertension; and (d) acute worsening of hypertension in a patient with previously stable control. […] It is important to diagnose these patients, as they often have increased cardiovascular morbidity and mortality than age-, sex- and BP-matched patients with essential hypertension, and treatment can lead to reversal of end-organ damage. […] Hypertension due to renal causes can be categorised as resulting from renovascular causes and renal parenchymal disease. […] Clinical situations that alert a physician to RAS are 30% rise in serum creatinine level after initiation of an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), discrepancy in kidney sizes of more than 1.5 cm or recurrent flash pulmonary oedema in a patient with normal left ventricular ejection fraction.

• #44 Evaluation of secondary hypertension – UpToDate

  https://www.uptodate.com/contents/evaluation-of-secondary-hypertension

  INTRODUCTION The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure control since many forms of secondary hypertension lead to „treatment-resistant” hypertension. […] By contrast, patients who have clinical clues suggesting the possible presence of secondary hypertension should undergo a more extensive evaluation. If secondary hypertension is present, the most effective treatment strategy often is one that is focused upon the specific mechanism underlying the hypertension. In addition, some of these disorders can be cured, leading to partial or complete normalization of the blood pressure. […] Because it is not cost effective to perform a complete evaluation for secondary hypertension in every hypertensive patient, it is important to be aware of the clinical clues that suggest secondary hypertension. The identification of patients who should undergo an evaluation for secondary hypertension will be reviewed here.

• #45 Whom should you test for secondary causes of hypertension? | MDedge

  https://mdedge.com/jfponline/article/79621/pediatrics/whom-should-you-test-secondary-causes-hypertension

  According to the Institute for Clinical Systems Improvement (ICSI), patients at highest risk for secondary hypertension have no family history of hypertension; abrupt onset, symptomatic, or crisis hypertension; stage 2 hypertension; sudden loss of hypertensive control; and drug-resistant hypertension. […] The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that patients with the following characteristics undergo further directed evaluation for a secondary cause: younger than 30 years with no family history of hypertension; older than 55 years with new hypertension; abdominal bruit with diastolic component; sudden worsening of BP control; recurrent flash pulmonary edema; renal failure with abnormal urinary sediment or proteinuria; acute renal failure after administration of an ACE inhibitor or ARB.

• #46 Approach to the diagnosis of secondary hypertension in adults

  https://australianprescriber.tg.org.au/articles/approach-to-the-diagnosis-of-secondary-hypertension-in-adults.html

  Presentations that should raise suspicion of secondary hypertension include early-onset, severe or resistant hypertension. A suggestive family history or clinical clues can point to a specific secondary cause. […] The most common causes and associations are renal disease, primary aldosteronism and obstructive sleep apnoea. Medicines, illicit substances and alcohol may also be responsible. […] Secondary hypertension occurs in approximately 10% of adults with hypertension. There are many possible causes. Identifying and treating the cause can potentially cure or markedly improve hypertension and reduce the associated cardiovascular risk. […] All patients suspected of having secondary hypertension should be screened for the common causes and associations. These include renal disease (parenchymal or renovascular), primary aldosteronism, medicines, illicit substances, alcohol and obstructive sleep apnoea. […] Identifying secondary hypertension presents an opportunity to modify a patients cardiovascular risk profile beyond what is achievable by antihypertensive therapy alone. Renal disease and primary aldosteronism are common causes.

• #47

  https://step2.medbullets.com/evidence/29094913

  Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.

• #48 Secondary Hypertension – Causes, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/secondary-hypertension-causes-symptoms-and-treatment/

  Secondary hypertension is a result of other medical conditions. It can develop if you have a kidney, heart, artery, or endocrine disease. […] Some of the following conditions may point towards secondary hypertension: High blood pressure, which does not respond to blood pressure medicines (resistant hypertension) including those medicines that were used earlier to control the hypertension. […] Secondary hypertension is also likely when there is elevated blood pressure without a family history of high blood pressure or obesity. […] There are many causes: Renal: Injuries to the kidney or narrowing of its arteries can result in poor blood flow. It can lead to increased production of a hormone called renin, which can increase blood pressure. […] Medical conditions may include: Cushing syndrome: Either the corticosteroid medications for this condition may cause secondary hypertension, it is caused by a pituitary tumor or anything that makes the adrenal glands produce too much of cortisol hormone.

Zobacz więcej