Materiały źródłowe

• #1 Secondary Hypertension – StatPearls – NCBI Bookshelf

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

  Secondary hypertension is defined as elevated blood pressure (BP) secondary to an identifiable cause. […] Identification of the etiology and pathophysiology of secondary hypertension is essential in selected groups of patients. It does not just guide towards the appropriate therapy, it may result in a complete cure of hypertension and elimination of antihypertensive therapy. […] The factors responsible for secondary hypertension result in arterial hypertension by affecting the aforementioned determinants of blood pressure. […] Renal parenchymal diseases lead to impaired renal function that results in intravascular volume expansion. While an inappropriate activation of the renin-angiotensin-aldosterone and sympathetic system is the other mechanism responsible for hypertension in renal parenchymal diseases.

• #2 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). […] Regardless of the cause, arterial pressure becomes elevated because of an increase in cardiac output, an increase in systemic vascular resistance, or both. When cardiac output is elevated, it is because of either increased neurohumoral activation of the heart or increased blood volume. Increased systemic vascular resistance is most commonly caused, at least initially, by increased sympathetic activation or by the effects of circulating vasoconstrictors (e.g., angiotensin II). […] Patients with secondary hypertension are best treated by controlling or removing the underlying disease or pathology, although they may still require antihypertensive drugs.

• #3 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. […] 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. […] 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. […] 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.

• #4 Secondary Hypertension – StatPearls – NCBI Bookshelf

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

  Secondary hypertension is defined as elevated blood pressure (BP) secondary to an identifiable cause. […] Identification of the etiology and pathophysiology of secondary hypertension is essential in selected groups of patients. It does not just guide towards the appropriate therapy, it may result in a complete cure of hypertension and elimination of antihypertensive therapy. […] The factors responsible for secondary hypertension result in arterial hypertension by affecting the aforementioned determinants of blood pressure. […] Renal parenchymal diseases lead to impaired renal function that results in intravascular volume expansion. While an inappropriate activation of the renin-angiotensin-aldosterone and sympathetic system is the other mechanism responsible for hypertension in renal parenchymal diseases.

• #5 Secondary hypertension – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/secondary-hypertension/symptoms-causes/syc-20350679

  Secondary high blood pressure (secondary hypertension) is high blood pressure that’s caused by another medical condition. It can be caused by conditions that affect the kidneys, arteries, heart or endocrine system. […] Proper treatment of secondary hypertension can often control both the high blood pressure and the condition that causes it. Effective treatment reduces the risk of serious complications including heart disease, kidney failure and stroke. […] Many health conditions can cause secondary hypertension. Several kidney diseases may cause secondary hypertension, including: […] Renovascular hypertension is often caused by the same type of fatty plaques that can damage the coronary arteries (atherosclerosis) or a separate condition in which the muscle and fibrous tissues of the renal artery wall thicken and harden into rings (fibromuscular dysplasia).

• #6 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). […] Regardless of the cause, arterial pressure becomes elevated because of an increase in cardiac output, an increase in systemic vascular resistance, or both. When cardiac output is elevated, it is because of either increased neurohumoral activation of the heart or increased blood volume. Increased systemic vascular resistance is most commonly caused, at least initially, by increased sympathetic activation or by the effects of circulating vasoconstrictors (e.g., angiotensin II). […] Patients with secondary hypertension are best treated by controlling or removing the underlying disease or pathology, although they may still require antihypertensive drugs.

• #7 Secondary Hypertension: Causes & Symptoms

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

  Secondary hypertension is high blood pressure that has a known cause. The cause might be another medical condition, or certain medicines or substances youre using. Often, treating this underlying cause can reduce your blood pressure to healthier levels. […] Most cases of hypertension are primary. Experts used to think that only 5% to 10% of high blood pressure cases have secondary causes. But recent research shows the actual number of secondary hypertension cases may be much higher. This is because many cases go unrecognized or are diagnosed as primary hypertension. […] 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.

• #8 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. […] 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. […] 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. […] 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.

• #9 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). […] Secondary hypertension also should be considered in patients with resistant hypertension, and early or late onset of hypertension. The prevalence of secondary hypertension and the most common etiologies vary by age group. 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.

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

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

  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. […] 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 (defined as elevated blood pressure despite patient adherence to optimal dosages of three antihypertensive agents, including a diuretic), early or late onset of hypertension, a severe or accelerated course, or specific drug intolerances.

• #11 Chapter 12. Secondary hypertension | Hypertension Research

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

  Sleep apnea syndrome is often accompanied by obesity, and blood pressure increases markedly during apneic periods. […] Neurogenic hypertension is also caused by increases in intracranial pressure due to brain tumor or other causes, cerebrovascular disorders, hyperventilation and panic disorder. […] Hypertension may also be brought on by various drugs that cause Na retention or sympathetic activation. […] Secondary hypertension is considered to account for about 10% of all hypertension. […] The possibility of secondary hypertension is higher in hypertension with an early onset, severe hypertension and resistant hypertension. […] The possibility of secondary hypertension should be considered in the diagnosis and treatment of all hypertensive patients. […] Renal parenchymal hypertension is hypertension occurring with renal parenchymal disorders and is one of the most frequent forms of secondary hypertension.

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

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

  Secondary hypertension can be caused by renal or endocrine disorders. […] Renal parenchymal disease is the most common cause of secondary hypertension. Responsible for 2% to 5% of cases. Virtually all disorders of the kidney may cause hypertension. […] Hypertension is present in 80% of patients with chronic renal failure. In general, hypertension is more severe in glomerular diseases than in interstitial diseases. […] Most renovascular hypertension develops from partial obstruction of one main renal artery. […] In the initial stages activation of the RAS system over time, recruitment of other pressure mechanisms may contribute to elevated arterial pressure. […] Primary aldosteronism is a very uncommon cause. However, in studies systematically screening all patients with HTN prevalence varies from 5% to 12% of hypertensive individuals.

• #13 Secondary Hypertension – StatPearls – NCBI Bookshelf

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

  Secondary hypertension is defined as elevated blood pressure (BP) secondary to an identifiable cause. […] Identification of the etiology and pathophysiology of secondary hypertension is essential in selected groups of patients. It does not just guide towards the appropriate therapy, it may result in a complete cure of hypertension and elimination of antihypertensive therapy. […] The factors responsible for secondary hypertension result in arterial hypertension by affecting the aforementioned determinants of blood pressure. […] Renal parenchymal diseases lead to impaired renal function that results in intravascular volume expansion. While an inappropriate activation of the renin-angiotensin-aldosterone and sympathetic system is the other mechanism responsible for hypertension in renal parenchymal diseases.

• #14 Secondary Hypertension | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28819

  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. […] Drug-induced hypertension is a significant cause of secondary hypertension. […] Arterial blood pressure is determined by cardiac output and vascular compliance (systemic vascular resistance), therefore a high cardiac output and high systemic vascular resistance are the primary mechanisms of hypertension. […] Renal parenchymal diseases lead to impaired renal function that results in intravascular volume expansion.

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

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

  Secondary hypertension can be caused by renal or endocrine disorders. […] Renal parenchymal disease is the most common cause of secondary hypertension. Responsible for 2% to 5% of cases. Virtually all disorders of the kidney may cause hypertension. […] Hypertension is present in 80% of patients with chronic renal failure. In general, hypertension is more severe in glomerular diseases than in interstitial diseases. […] Most renovascular hypertension develops from partial obstruction of one main renal artery. […] In the initial stages activation of the RAS system over time, recruitment of other pressure mechanisms may contribute to elevated arterial pressure. […] Primary aldosteronism is a very uncommon cause. However, in studies systematically screening all patients with HTN prevalence varies from 5% to 12% of hypertensive individuals.

• #16 Chapter 12. Secondary hypertension | Hypertension Research

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

  As hypertension accelerates the progression of nephropathy, antihypertensive treatment is important for both the prevention of cardiovascular events and the protection of the kidney. […] Renovascular hypertension is hypertension caused by stenosis or obstruction of the renal artery, and is observed in about 1% of all hypertensive patients. […] Its primary cause is atherosclerosis in middle-aged and elderly patients and fibromuscular dysplasia in younger patients. […] Renovascular hypertension often presents as severe or resistant hypertension. […] Renovascular hypertension is often grade III and may cause malignant hypertension. […] Renal failure caused by bilateral renal artery stenosis is called ischemic nephropathy. […] Renovascular hypertension is hypertension caused by stenosis or obstruction of the renal artery and is observed in about 1% of hypertensive patients.

• #17 Chapter 12. Secondary hypertension | Hypertension Research

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

  As hypertension accelerates the progression of nephropathy, antihypertensive treatment is important for both the prevention of cardiovascular events and the protection of the kidney. […] Renovascular hypertension is hypertension caused by stenosis or obstruction of the renal artery, and is observed in about 1% of all hypertensive patients. […] Its primary cause is atherosclerosis in middle-aged and elderly patients and fibromuscular dysplasia in younger patients. […] Renovascular hypertension often presents as severe or resistant hypertension. […] Renovascular hypertension is often grade III and may cause malignant hypertension. […] Renal failure caused by bilateral renal artery stenosis is called ischemic nephropathy. […] Renovascular hypertension is hypertension caused by stenosis or obstruction of the renal artery and is observed in about 1% of hypertensive patients.

• #18 Secondary Hypertension | Abdominal Key

  https://abdominalkey.com/secondary-hypertension/

  Renovascular hypertension (RVHT) is the most common cause of secondary hypertension in the United States. […] RVHT is an elevation of blood pressure (BP) due to activation of the reninangiotensin system in the setting of renal artery occlusive disease. […] The mechanism of development of hypertension is mediated via the reninangiotensinaldosterone system (RAAS) with salt and water retention. […] In unilateral RAS (2K-1C model), renal perfusion pressure is decreased in the kidney distal to the stenosis, which leads to increased renin production, which in turn forms angiotensin II (AT II). […] On the other hand, in the 2K-2C or 1K-1C models representing bilateral RAS or RAS to a solitary kidney, there is an initial increase in renin, which in turn causes an increase in AT II and aldosterone.

• #19 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  Causes of hypertensionThere are two basic types of hypertension: primary (essential) hypertension and secondary hypertension. A smaller number of patients (5-10%) have secondary hypertension that is caused by an identifiable underlying condition such as renal artery disease, thyroid disease, primary hyperaldosteronism, pregnancy, etc. […] Some causes of secondary hypertension are listed below: […] Renal artery disease can cause narrowing of the vessel lumen (stenosis). The reduced lumen diameter increases the pressure drop along the length of the diseased renal artery, which reduces the pressure at the afferent arteriole in the kidney. […] Chronic elevation of AII promotes cardiac and vascular hypertrophy. Therefore, hypertension caused by renal artery stenosis results from both an increase in systemic vascular resistance and an increase in cardiac output.

• #20 CV Physiology | Secondary Hypertension

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

  Renovascular hypertensionRenal artery disease can cause narrowing of the vessel lumen (stenosis). The reduced lumen diameter decreases the pressure at the afferent arteriole in the kidney and reduces renal perfusion. This stimulates renin release by the kidney, which increases circulating angiotensin II (AII) and aldosterone. […] The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. […] Increased circulating aldosterone causes renal retention of sodium and water, which causes blood volume and arterial pressure to increase. […] 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.

• #21 Secondary Hypertension | Abdominal Key

  https://abdominalkey.com/secondary-hypertension/

  Renovascular hypertension (RVHT) is the most common cause of secondary hypertension in the United States. […] RVHT is an elevation of blood pressure (BP) due to activation of the reninangiotensin system in the setting of renal artery occlusive disease. […] The mechanism of development of hypertension is mediated via the reninangiotensinaldosterone system (RAAS) with salt and water retention. […] In unilateral RAS (2K-1C model), renal perfusion pressure is decreased in the kidney distal to the stenosis, which leads to increased renin production, which in turn forms angiotensin II (AT II). […] On the other hand, in the 2K-2C or 1K-1C models representing bilateral RAS or RAS to a solitary kidney, there is an initial increase in renin, which in turn causes an increase in AT II and aldosterone.

• #22 Secondary Hypertension | Abdominal Key

  https://abdominalkey.com/secondary-hypertension/

  This form of hypertension is considered volume mediated, whereas the 2K-1C model of unilateral RAS is renin mediated. […] The pathophysiology of renovascular hypertension is best explained by the sentinel animal experiments by Goldblatt. […] In Goldblatts experimental models, 8085% renal artery constriction induces significant hemodynamic changes. […] By definition RVHT requires an elevation of BP due to the activation of the reninangiotensin system in the setting of renal artery occlusive disease.

• #23 Secondary Hypertension | Abdominal Key

  https://abdominalkey.com/secondary-hypertension/

  This form of hypertension is considered volume mediated, whereas the 2K-1C model of unilateral RAS is renin mediated. […] The pathophysiology of renovascular hypertension is best explained by the sentinel animal experiments by Goldblatt. […] In Goldblatts experimental models, 8085% renal artery constriction induces significant hemodynamic changes. […] By definition RVHT requires an elevation of BP due to the activation of the reninangiotensin system in the setting of renal artery occlusive disease.

• #24 CV Physiology | Secondary Hypertension

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

  Renovascular hypertensionRenal artery disease can cause narrowing of the vessel lumen (stenosis). The reduced lumen diameter decreases the pressure at the afferent arteriole in the kidney and reduces renal perfusion. This stimulates renin release by the kidney, which increases circulating angiotensin II (AII) and aldosterone. […] The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. […] Increased circulating aldosterone causes renal retention of sodium and water, which causes blood volume and arterial pressure to increase. […] 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.

• #25 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  When this occurs, the kidney cannot excrete normal amounts of sodium, which leads to sodium and water retention, increased blood volume, and increased cardiac output by the Frank-Starling mechanism. […] The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. […] Increased secretion of aldosterone resulting from adrenal adenoma or adrenal hyperplasia is a form of primary hyperaldosteronism. […] Increased circulating aldosterone causes renal retention of sodium and water, therefore blood volume and arterial pressure increase. […] Activation of the sympathetic nervous system increases circulating angiotensin II, aldosterone, and vasopressin, which increases systemic vascular resistance and blood volume.

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

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

  Secondary hypertension can be caused by renal or endocrine disorders. […] Renal parenchymal disease is the most common cause of secondary hypertension. Responsible for 2% to 5% of cases. Virtually all disorders of the kidney may cause hypertension. […] Hypertension is present in 80% of patients with chronic renal failure. In general, hypertension is more severe in glomerular diseases than in interstitial diseases. […] Most renovascular hypertension develops from partial obstruction of one main renal artery. […] In the initial stages activation of the RAS system over time, recruitment of other pressure mechanisms may contribute to elevated arterial pressure. […] Primary aldosteronism is a very uncommon cause. However, in studies systematically screening all patients with HTN prevalence varies from 5% to 12% of hypertensive individuals.

• #27 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. […] 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%. […] The aldosterone-renin ratio (ARR) is the most reliable test for screening purposes. […] If biochemical evidence for hyperaldosteronism can be confirmed, then the next step is imaging of the adrenal glands, i.e., by computed tomography. […] Even in the general population, and particularly in men, obstructive sleep apnoea (OSA) is a common finding. […] Approximately 30% of adults with hypertension have OSA.

• #28 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. […] 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%. […] The aldosterone-renin ratio (ARR) is the most reliable test for screening purposes. […] If biochemical evidence for hyperaldosteronism can be confirmed, then the next step is imaging of the adrenal glands, i.e., by computed tomography. […] Even in the general population, and particularly in men, obstructive sleep apnoea (OSA) is a common finding. […] Approximately 30% of adults with hypertension have OSA.

• #29 Secondary Hypertension – StatPearls – NCBI Bookshelf

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

  In endocrine disorders, different hormones are responsible for hypertension. In primary aldosteronism, higher levels of aldosterone result in volume expansion (by salt retention), while cortisol plays a similar role in Cushing`s syndrome. […] Increased systemic vascular resistance is the primary mechanism of hypertension in vascular disorders, while secondary hyperaldosteronism plays a major role in the development of hypertension in renal artery stenosis.

• #30 CV Physiology | Secondary Hypertension

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

  Renovascular hypertensionRenal artery disease can cause narrowing of the vessel lumen (stenosis). The reduced lumen diameter decreases the pressure at the afferent arteriole in the kidney and reduces renal perfusion. This stimulates renin release by the kidney, which increases circulating angiotensin II (AII) and aldosterone. […] The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. […] Increased circulating aldosterone causes renal retention of sodium and water, which causes blood volume and arterial pressure to increase. […] 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.

• #31 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  When this occurs, the kidney cannot excrete normal amounts of sodium, which leads to sodium and water retention, increased blood volume, and increased cardiac output by the Frank-Starling mechanism. […] The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. […] Increased secretion of aldosterone resulting from adrenal adenoma or adrenal hyperplasia is a form of primary hyperaldosteronism. […] Increased circulating aldosterone causes renal retention of sodium and water, therefore blood volume and arterial pressure increase. […] Activation of the sympathetic nervous system increases circulating angiotensin II, aldosterone, and vasopressin, which increases systemic vascular resistance and blood volume.

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

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

  The clinical hallmark of mineralocorticoid excess is hypokalemic hypertension. […] The diagnosis of primary aldosteronism can be confirmed by demonstrating failure to suppress plasma aldosterone to (5 ng/dL) after IV infusion of 2 L of isotonic saline over 4 h. […] Hypertension occurs in 75-80% of patients with Cushing’s syndrome. Mechanism: stimulation of mineralocorticoid receptors. […] The diagnosis is based on documentation of catecholamine excess by biochemical testing. […] The diagnosis of pheochromocytoma is based on elevated plasma and urinary levels of catecholamines and metanephrines. […] Coarctation of the aorta is the most common congenital cardiovascular cause of hypertension. […] Hypertension due to obstructive sleep apnea should be considered in patients with drug-resistant hypertension and history of snoring.

• #33 CV Physiology | Secondary Hypertension

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

  The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of 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 (both epinephrine and norepinephrine). This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure. […] This is a serious condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume, which increases cardiac output by the Frank-Starling mechanism. […] 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. Obstruction of the aorta at this point reduces distal arterial pressures and elevates arterial pressures in the head and arms.

• #34 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. It should be suspected in those who develop hypertension after 50 years of age, have known atherosclerosis elsewhere, have unexplained renal insufficiency, or have a rapid deterioration in kidney function. […] Hypertension can be a major cause of renal parenchymal damage, particularly in older adults, which in turn leads to worsening hypertension.

• #35 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  Sleep apnea is a disorder in which people repeatedly stop breathing for short periods of time (1030 seconds) during their sleep. […] The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of sleep. […] Excessive thyroid hormone induces systemic vasoconstriction, increased blood volume, and increased cardiac activity, all of which can lead to hypertension. […] Catecholamine secreting tumors in the adrenal medulla can lead to very high levels of circulating catecholamines (both epinephrine and norepinephrine). […] This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure.

• #36 Secondary Hypertension – Hypertension Etiology & Classification

  http://www.health.am/hypertension/secondary-hypertension/

  Most cases are related to increased intravascular volume or increased activity of the renin-angiotensin-aldosterone system. […] Hypertension can be caused by mutations in single genes, inherited on a mendelian basis. […] Although rare, these conditions provide important insight into blood pressure regulation and possibly, the genetic basis of essential hypertension. […] Primary hyperaldosteronism occurs because of excessive secretion of aldosterone by the adrenal cortex. […] It may, in fact, be the most common potentially curable and specifically treatable cause of hypertension. […] The exact pathogenesis of the hypertension is unclear. […] The blood pressure elevation caused by the catecholamine excess results from two mechanisms: -receptor-mediated vasoconstriction of arterioles, leading to an increase in peripheral resistance, and 1-receptor-mediated increases in cardiac output and in renin release, leading to increased circulating levels of angiotensin II.

• #37 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. […] 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. […] 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. […] 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.

• #38 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. […] 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. […] 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. […] 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.

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

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

  The clinical hallmark of mineralocorticoid excess is hypokalemic hypertension. […] The diagnosis of primary aldosteronism can be confirmed by demonstrating failure to suppress plasma aldosterone to (5 ng/dL) after IV infusion of 2 L of isotonic saline over 4 h. […] Hypertension occurs in 75-80% of patients with Cushing’s syndrome. Mechanism: stimulation of mineralocorticoid receptors. […] The diagnosis is based on documentation of catecholamine excess by biochemical testing. […] The diagnosis of pheochromocytoma is based on elevated plasma and urinary levels of catecholamines and metanephrines. […] Coarctation of the aorta is the most common congenital cardiovascular cause of hypertension. […] Hypertension due to obstructive sleep apnea should be considered in patients with drug-resistant hypertension and history of snoring.

• #40 Secondary Hypertension – StatPearls – NCBI Bookshelf

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

  In endocrine disorders, different hormones are responsible for hypertension. In primary aldosteronism, higher levels of aldosterone result in volume expansion (by salt retention), while cortisol plays a similar role in Cushing`s syndrome. […] Increased systemic vascular resistance is the primary mechanism of hypertension in vascular disorders, while secondary hyperaldosteronism plays a major role in the development of hypertension in renal artery stenosis.

• #41 Secondary hypertension – Wikipedia

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

  Neurogenic hypertension excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction resulting from chronic high activity of the sympathoadrenal system, the sympathetic nervous system and the adrenal gland. […] A variety of adrenal cortical abnormalities can cause hypertension, In primary aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension. […] Congenital adrenal hyperplasia, a group of autosomal recessive disorders of the enzymes responsible for steroid hormone production, can lead to secondary hypertension by creating atypically high levels of mineralocorticoid steroid hormones. […] Cortisol induced hypertension cannot be completely explained by the activity of Cortisol on Aldosterone receptors. […] Neuroendocrine tumors are also a well known cause of secondary hypertension.

• #42 CV Physiology | Secondary Hypertension

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

  The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of 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 (both epinephrine and norepinephrine). This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure. […] This is a serious condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume, which increases cardiac output by the Frank-Starling mechanism. […] 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. Obstruction of the aorta at this point reduces distal arterial pressures and elevates arterial pressures in the head and arms.

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

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

  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.

• #44 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  Sleep apnea is a disorder in which people repeatedly stop breathing for short periods of time (1030 seconds) during their sleep. […] The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of sleep. […] Excessive thyroid hormone induces systemic vasoconstriction, increased blood volume, and increased cardiac activity, all of which can lead to hypertension. […] Catecholamine secreting tumors in the adrenal medulla can lead to very high levels of circulating catecholamines (both epinephrine and norepinephrine). […] This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure.

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

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

  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.

• #46 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. […] The intermittent hypoxia and resultant hypercapnia that is characteristic of OSA leads to activation of the sympathetic nervous system and leads to elevated blood pressure.

• #47 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. […] 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%. […] The aldosterone-renin ratio (ARR) is the most reliable test for screening purposes. […] If biochemical evidence for hyperaldosteronism can be confirmed, then the next step is imaging of the adrenal glands, i.e., by computed tomography. […] Even in the general population, and particularly in men, obstructive sleep apnoea (OSA) is a common finding. […] Approximately 30% of adults with hypertension have OSA.

• #48 CV Physiology | Secondary Hypertension

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

  The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of 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 (both epinephrine and norepinephrine). This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure. […] This is a serious condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume, which increases cardiac output by the Frank-Starling mechanism. […] 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. Obstruction of the aorta at this point reduces distal arterial pressures and elevates arterial pressures in the head and arms.

• #49 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  Sleep apnea is a disorder in which people repeatedly stop breathing for short periods of time (1030 seconds) during their sleep. […] The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of sleep. […] Excessive thyroid hormone induces systemic vasoconstriction, increased blood volume, and increased cardiac activity, all of which can lead to hypertension. […] Catecholamine secreting tumors in the adrenal medulla can lead to very high levels of circulating catecholamines (both epinephrine and norepinephrine). […] This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure.

• #50 Resistant Hypertension: An Overview | ECR Journal

  https://www.ecrjournal.com/articles/global-burden-resistant-hypertension-and-potential-treatment-options?language_content_entity=en

  Sleep is a crucial component of overall health and disruptions in sleep patterns has been associated with an increased risk of hypertension and CV disease as a result of sympathetic overactivity. OSA is a common sleep disorder characterised by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. It is a particularly strong risk factor for the development of RH. Recurrent hypoxia occurring in patients with OSA triggers endothelial dysfunction and activates the RAAS and sympathetic systems, leading to systemic inflammation and oxidative stress that contribute to RH and HMOD occurrence. […] Several classes of drugs can increase BP through various mechanisms, such as increased systemic and renal vasoconstriction, sodium retention and angiotensin biosynthesis. These pharmacological agents include nonsteroidal anti-inflammatory agents, oral contraceptives, immunosuppressive treatments such as cyclosporine and tacrolimus, antineoplastic drugs targeting the vascular endothelial growth factor pathway, steroids and antidepressants.

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

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

  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.

• #52 CV Pharmacology | Systemic Hypertension ^cont.

  https://cvpharmacology.com/clinical-topics/hypertension-3

  This is a condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume and tachycardia. […] Coarctation, or narrowing of the aorta (typically just distal to the left subclavian artery), is a congenital defect that obstructs aortic outflow, leading to elevated pressures proximal to the coarctation (i.e., elevated arterial pressures in the head and arms). […] This elevates blood volume and arterial pressure.

• #53 CV Physiology | Secondary Hypertension

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

  The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnia, and from stress associated with the loss of 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 (both epinephrine and norepinephrine). This leads to alpha-adrenoceptor mediated systemic vasoconstriction and beta-adrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure. […] This is a serious condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume, which increases cardiac output by the Frank-Starling mechanism. […] 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. Obstruction of the aorta at this point reduces distal arterial pressures and elevates arterial pressures in the head and arms.

• #54 Ruling out secondary causes of hypertension | EuroIntervention

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

  OSA is a strong and independent risk factor for the presence of hypertension and cardiovascular diseases. […] Drug-induced hypertension is one of the most common causes of secondary hypertension and is often found in clinical practice. […] The use of non-steroidal anti-inflammatory drugs (NSAIDs) for example is often the cause of drug-induced hypertension. […] Although the prevalence of pheochromocytoma in the general hypertensive population is very low, diagnosis and treatment are extremely important in view of the possibility of precipitating hypertensive crisis if the tumour is stimulated. […] In contrast, hypertension is one of the most distinguishing features of endogenous Cushings syndrome, and can be found in about 80% of adult patients. […] Coarctation of the aorta is a common cause of secondary hypertension in children, milder cases may first be detected as a rare cause of arterial hypertension in adults.

• #55 Secondary Hypertension: Causes & Symptoms

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

  Secondary hypertension is high blood pressure that has a known cause. The cause might be another medical condition, or certain medicines or substances youre using. Often, treating this underlying cause can reduce your blood pressure to healthier levels. […] Most cases of hypertension are primary. Experts used to think that only 5% to 10% of high blood pressure cases have secondary causes. But recent research shows the actual number of secondary hypertension cases may be much higher. This is because many cases go unrecognized or are diagnosed as primary hypertension. […] 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.

• #56 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).

• #57 Drug-induced causes of secondary hypertension

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

  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. […] Mineralocorticoids including licorice, carbenoxolone, 9-alpha fluorocortisol, ketoconazole, and carbenoxolone may cause an elevated blood pressure (4,16). The increase in blood pressure caused by these drugs is dose-dependent and is associated with hypokalemia, metabolic alkalosis, and a reduction in plasma renin activity and aldosterone levels (4,9). […] 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).

• #58

  https://journals.lww.com/jhypertension/abstract/2021/04001/prevalence_of_secondary_hypertension_in_patients.1078.aspx

  Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. […] Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). […] Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (515%). Patients with secondary hypertension had more advanced target organ damage.

• #59 Resistant Hypertension: An Overview | ECR Journal

  https://www.ecrjournal.com/articles/global-burden-resistant-hypertension-and-potential-treatment-options?language_content_entity=en

  The pathophysiology of RH involves an interplay between several neurohumoral factors, including increased sympathetic activity and levels of aldosterone, endothelin-1 and vasopressin. These factors induce volume and sodium overload and contribute to increased peripheral vascular resistance, arterial stiffness and HMOD occurrence. […] Several conditions contribute to such mechanisms. Obesity is an important risk factor for RH development. Findings from NHANES demonstrated that BMI 30 kg/m2 approximately doubles the risk of aRH. In particular, visceral adiposity plays a fundamental role in RH occurrence through a variety of mechanisms, including enhanced salt sensitivity, vascular dysfunction and activation of the sympathetic nervous system and RAAS. […] Several studies have also reported new or exacerbated RH in patients with previous severe acute respiratory syndrome coronavirus 2 infection. The exact mechanism linking such conditions may involve the binding of the spike protein to angiotensin converting enzyme-2 (ACE2) receptors on the cell surface leading to ACE2 downregulation and failure of the counter-regulatory RAAS axis.

• #60 Resistant Hypertension: An Overview | ECR Journal

  https://www.ecrjournal.com/articles/global-burden-resistant-hypertension-and-potential-treatment-options?language_content_entity=en

  The pathophysiology of RH involves an interplay between several neurohumoral factors, including increased sympathetic activity and levels of aldosterone, endothelin-1 and vasopressin. These factors induce volume and sodium overload and contribute to increased peripheral vascular resistance, arterial stiffness and HMOD occurrence. […] Several conditions contribute to such mechanisms. Obesity is an important risk factor for RH development. Findings from NHANES demonstrated that BMI 30 kg/m2 approximately doubles the risk of aRH. In particular, visceral adiposity plays a fundamental role in RH occurrence through a variety of mechanisms, including enhanced salt sensitivity, vascular dysfunction and activation of the sympathetic nervous system and RAAS. […] Several studies have also reported new or exacerbated RH in patients with previous severe acute respiratory syndrome coronavirus 2 infection. The exact mechanism linking such conditions may involve the binding of the spike protein to angiotensin converting enzyme-2 (ACE2) receptors on the cell surface leading to ACE2 downregulation and failure of the counter-regulatory RAAS axis.

• #61

  https://journals.lww.com/jhypertension/abstract/2021/04001/prevalence_of_secondary_hypertension_in_patients.1078.aspx

  Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. […] Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). […] Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (515%). Patients with secondary hypertension had more advanced target organ damage.

• #62

  https://journals.lww.com/jhypertension/abstract/2021/04001/prevalence_of_secondary_hypertension_in_patients.1078.aspx

  Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. […] Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). […] Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (515%). Patients with secondary hypertension had more advanced target organ damage.

• #63 Resistant Hypertension: An Overview | ECR Journal

  https://www.ecrjournal.com/articles/global-burden-resistant-hypertension-and-potential-treatment-options?language_content_entity=en

  The pathophysiology of RH involves an interplay between several neurohumoral factors, including increased sympathetic activity and levels of aldosterone, endothelin-1 and vasopressin. These factors induce volume and sodium overload and contribute to increased peripheral vascular resistance, arterial stiffness and HMOD occurrence. […] Several conditions contribute to such mechanisms. Obesity is an important risk factor for RH development. Findings from NHANES demonstrated that BMI 30 kg/m2 approximately doubles the risk of aRH. In particular, visceral adiposity plays a fundamental role in RH occurrence through a variety of mechanisms, including enhanced salt sensitivity, vascular dysfunction and activation of the sympathetic nervous system and RAAS. […] Several studies have also reported new or exacerbated RH in patients with previous severe acute respiratory syndrome coronavirus 2 infection. The exact mechanism linking such conditions may involve the binding of the spike protein to angiotensin converting enzyme-2 (ACE2) receptors on the cell surface leading to ACE2 downregulation and failure of the counter-regulatory RAAS axis.

• #64 Resistant Hypertension: An Overview | ECR Journal

  https://www.ecrjournal.com/articles/global-burden-resistant-hypertension-and-potential-treatment-options?language_content_entity=en

  There is limited evidence on RH heritability. Most genetic research on RH has been limited to candidate genes and lack adequate sample sizes. One of the genes potentially involved in RH susceptibility is the angiotensinogen (AGT) gene, encoding a protein that is a precursor to angiotensin II. The M235T polymorphism of the AGT gene, in particular, is associated with increased plasma angiotensinogen levels leading to increased risk of hypertension. Genetic variants in the adrenergic receptor genes may be also linked to the development of RH. Larger studies in well-characterised individuals with RH are needed to clarify these aspects.

• #65 Hypertension: Practice Essentials, Background, Pathophysiology

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

  The pathogenesis of primary hypertension is multifactorial and complex. […] The pathogenesis of primary hypertension involves multiple factors, including genetic predisposition, excess dietary salt intake, adrenergic tone, and renal sodium and water handling that interact to produce BP elevations. […] Emerging evidence suggests a role for immune cell activation and the microbiome in the pathogenesis of hypertension. […] Investigations into the pathophysiology of hypertension, both in animals and humans, have revealed that hypertension may have an immunologic basis. […] Evidence suggests that T lymphocytes and T-cell derived cytokines (eg, interleukin 17, tumor necrosis factor alpha) play an important role in hypertension. […] One hypothesis is that prehypertension results in oxidation of lipids such as arachidonic acid that leads to the formation of isoketals or isolevuglandins, which function as neoantigens, which are then presented to T cells, leading to T-cell activation and infiltration of critical organs (eg, kidney, vasculature). […] Sympathetic nervous system activation and noradrenergic stimuli have also been shown to promote T-lymphocyte activation and infiltration, and contribute to the pathophysiology of hypertension.

• #66 Hypertension: Practice Essentials, Background, Pathophysiology

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

  The pathogenesis of primary hypertension is multifactorial and complex. […] The pathogenesis of primary hypertension involves multiple factors, including genetic predisposition, excess dietary salt intake, adrenergic tone, and renal sodium and water handling that interact to produce BP elevations. […] Emerging evidence suggests a role for immune cell activation and the microbiome in the pathogenesis of hypertension. […] Investigations into the pathophysiology of hypertension, both in animals and humans, have revealed that hypertension may have an immunologic basis. […] Evidence suggests that T lymphocytes and T-cell derived cytokines (eg, interleukin 17, tumor necrosis factor alpha) play an important role in hypertension. […] One hypothesis is that prehypertension results in oxidation of lipids such as arachidonic acid that leads to the formation of isoketals or isolevuglandins, which function as neoantigens, which are then presented to T cells, leading to T-cell activation and infiltration of critical organs (eg, kidney, vasculature). […] Sympathetic nervous system activation and noradrenergic stimuli have also been shown to promote T-lymphocyte activation and infiltration, and contribute to the pathophysiology of hypertension.

• #67 Hypertension: Practice Essentials, Background, Pathophysiology

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

  The pathogenesis of primary hypertension is multifactorial and complex. […] The pathogenesis of primary hypertension involves multiple factors, including genetic predisposition, excess dietary salt intake, adrenergic tone, and renal sodium and water handling that interact to produce BP elevations. […] Emerging evidence suggests a role for immune cell activation and the microbiome in the pathogenesis of hypertension. […] Investigations into the pathophysiology of hypertension, both in animals and humans, have revealed that hypertension may have an immunologic basis. […] Evidence suggests that T lymphocytes and T-cell derived cytokines (eg, interleukin 17, tumor necrosis factor alpha) play an important role in hypertension. […] One hypothesis is that prehypertension results in oxidation of lipids such as arachidonic acid that leads to the formation of isoketals or isolevuglandins, which function as neoantigens, which are then presented to T cells, leading to T-cell activation and infiltration of critical organs (eg, kidney, vasculature). […] Sympathetic nervous system activation and noradrenergic stimuli have also been shown to promote T-lymphocyte activation and infiltration, and contribute to the pathophysiology of hypertension.

• #68 Pathophysiology of hypertension – Wikipedia

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

  Evidence suggests that oxidant stress alters many functions of the endothelium, including modulation of vasomotor tone. […] Inactivation of nitric oxide by superoxide and other reactive oxygen species seems to occur in conditions such as hypertension. […] Circulating endothelin levels are increased in some hypertensive patients, particularly African Americans and persons with hypertension. […] Basic science discoveries have implicated the immune system as in the development of hypertension in animal models. […] Population studies in humans have reported that higher levels of certain inflammatory cytokines are associated with greater risk of hypertension development.

• #69 Hypertension: Practice Essentials, Background, Pathophysiology

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

  The pathogenesis of primary hypertension is multifactorial and complex. […] The pathogenesis of primary hypertension involves multiple factors, including genetic predisposition, excess dietary salt intake, adrenergic tone, and renal sodium and water handling that interact to produce BP elevations. […] Emerging evidence suggests a role for immune cell activation and the microbiome in the pathogenesis of hypertension. […] Investigations into the pathophysiology of hypertension, both in animals and humans, have revealed that hypertension may have an immunologic basis. […] Evidence suggests that T lymphocytes and T-cell derived cytokines (eg, interleukin 17, tumor necrosis factor alpha) play an important role in hypertension. […] One hypothesis is that prehypertension results in oxidation of lipids such as arachidonic acid that leads to the formation of isoketals or isolevuglandins, which function as neoantigens, which are then presented to T cells, leading to T-cell activation and infiltration of critical organs (eg, kidney, vasculature). […] Sympathetic nervous system activation and noradrenergic stimuli have also been shown to promote T-lymphocyte activation and infiltration, and contribute to the pathophysiology of hypertension.

• #70 Pathophysiology of hypertension – Wikipedia

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

  Evidence suggests that oxidant stress alters many functions of the endothelium, including modulation of vasomotor tone. […] Inactivation of nitric oxide by superoxide and other reactive oxygen species seems to occur in conditions such as hypertension. […] Circulating endothelin levels are increased in some hypertensive patients, particularly African Americans and persons with hypertension. […] Basic science discoveries have implicated the immune system as in the development of hypertension in animal models. […] Population studies in humans have reported that higher levels of certain inflammatory cytokines are associated with greater risk of hypertension development.

• #71 Pathophysiology of hypertension – Wikipedia

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

  Evidence suggests that oxidant stress alters many functions of the endothelium, including modulation of vasomotor tone. […] Inactivation of nitric oxide by superoxide and other reactive oxygen species seems to occur in conditions such as hypertension. […] Circulating endothelin levels are increased in some hypertensive patients, particularly African Americans and persons with hypertension. […] Basic science discoveries have implicated the immune system as in the development of hypertension in animal models. […] Population studies in humans have reported that higher levels of certain inflammatory cytokines are associated with greater risk of hypertension development.

• #72 Secondary hypertension – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/secondary-hypertension/symptoms-causes/syc-20350679

  Secondary high blood pressure (secondary hypertension) is high blood pressure that’s caused by another medical condition. It can be caused by conditions that affect the kidneys, arteries, heart or endocrine system. […] Proper treatment of secondary hypertension can often control both the high blood pressure and the condition that causes it. Effective treatment reduces the risk of serious complications including heart disease, kidney failure and stroke. […] Many health conditions can cause secondary hypertension. Several kidney diseases may cause secondary hypertension, including: […] Renovascular hypertension is often caused by the same type of fatty plaques that can damage the coronary arteries (atherosclerosis) or a separate condition in which the muscle and fibrous tissues of the renal artery wall thicken and harden into rings (fibromuscular dysplasia).

• #73 Secondary Hypertension | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28819

  An inappropriate activation of the renin-angiotensin-aldosterone and sympathetic system is the other mechanism responsible for hypertension in renal parenchymal diseases. […] In endocrine disorders, different hormones are responsible for hypertension. […] Increased systemic vascular resistance is the primary mechanism of hypertension in vascular disorders, while secondary hyperaldosteronism plays a major role in the development of hypertension in renal artery stenosis. […] Secondary hypertension is usually resistant to antihypertensive drugs if the underlying mechanism is not identified and treated appropriately. […] However, with early identification and treatment of the underlying cause, secondary hypertension has a favorable prognosis.

• #74 Secondary Hypertension: Causes, Risk Factors, Diagnosis, Treatment

  https://www.webmd.com/hypertension-high-blood-pressure/secondary-hypertension-causes

  Secondary hypertension, which happens in about 10% of people with high blood pressure, is less common and is the result of another condition, such as: […] In order to treat secondary hypertension, your doctor will address the underlying condition or disorder. […] When the root cause of secondary hypertension is treated, blood pressure usually lowers or returns to normal.

• #75 Secondary Hypertension: Causes & Symptoms

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

  Secondary hypertension itself usually doesnt have symptoms (unless your blood pressure is very high). But you may develop symptoms from the underlying condition thats causing it. […] Untreated, secondary hypertension can lead to hypertensive heart disease. This is damage to your heart that results from years of high blood pressure. You may also develop complications from the condition thats raising your blood pressure. […] Secondary hypertension may be your providers first clue that you have another condition. Getting help for secondary hypertension may be the first step toward managing the underlying condition. […] Treatment depends on the cause. Since many different conditions can cause secondary hypertension, there are many possible treatments. Your healthcare provider will tailor a plan to your needs. […] Secondary hypertension has a positive outlook with treatment. Early detection and treatment can lower the risk of damage to your blood vessels and heart from ongoing high blood pressure.

• #76 Secondary Hypertension: Causes, Risk Factors, Diagnosis, Treatment

  https://www.webmd.com/hypertension-high-blood-pressure/secondary-hypertension-causes

  Secondary hypertension, which happens in about 10% of people with high blood pressure, is less common and is the result of another condition, such as: […] In order to treat secondary hypertension, your doctor will address the underlying condition or disorder. […] When the root cause of secondary hypertension is treated, blood pressure usually lowers or returns to normal.

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