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Before evaluating the patient for secondary hypertension, non-compliance with antihypertensives should be ruled out.  Given its prevalence in the Unites States population, sleep apnea should also be ruled out early in the evaluation.  
Before evaluating the patient for secondary hypertension, non-compliance with antihypertensives should be ruled out.  Given its prevalence in the Unites States population, sleep apnea should also be ruled out early in the evaluation.  


===Common Causes of Secondary Hypertension===
===Common Causes of Secondary Hypertension<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref>.===
Common causes of secondary hypertension include:
Common causes of secondary hypertension include:



Revision as of 16:09, 4 October 2012

Hypertension Main page

Overview

Causes

Classification

Primary Hypertension
Secondary Hypertension
Hypertensive Emergency
Hypertensive Urgency

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri

Overview

The most common cause of hypertension in 90% of cases is essential hypertension where no clear identifying underlying cause can be identified, and the pathophysiology of which is incompletely understood. There are many secondary causes of hypertension.

The Most Common Cause

The most common cause of hypertension is essential hypertension which accounts for about 90% of cases of elevated blood pressure.

Common Causes of Secondary Hypertension[1][2]

In only a small minority of patients with elevated arterial pressure can a specific cause be identified. An underlying endocrine or renal defect is most often identified, that if corrected, may restore the blood pressure back to normal.

When to Suspect Secondary Hypertension

A secondary cause of hypertension should be suspected if the patient has resistant hypertension. The AHA Scientific Statement 2008 defines resistant hypertension as a blood pressure which remains above the goal of 140/90 mm Hg despite concurrent use of 3 antihypertensive medications of different classes at optimal doses, including a diuretic.[3].

Other features that suggest secondary hypertension include:

Before evaluating the patient for secondary hypertension, non-compliance with antihypertensives should be ruled out. Given its prevalence in the Unites States population, sleep apnea should also be ruled out early in the evaluation.

Common Causes of Secondary Hypertension[4].

Common causes of secondary hypertension include:

  • Fever
  • Hyperaldosteronism (Conn's syndrome): Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension. Suspect hyperaldosteronism if the patient has an unusual sensitivity to a diuretic in causing hypokalemia, if there is frequent hypokalemia, and if there is a normal potassium in the setting of ACE inhibition with a potassium spairing diuretic. The plasma renin activity is suppressed and there is elevated aldosterone on adrenal vein sampling.
Tests to Assess for Renovascular Hypertension
  • Renal Ultrasound: Look for a difference in the size of kidneys
  • CT: Although there is a dye load, there is no Gadollinium which can be toxic with an MRI, the images are better than MRI
  • Indications for Arteriographic Imaging to Rule Out Renovascular Hypertension[5]
Class I
  • Hypertension in a patient < 30 yrs old
  • Severe increase in blood pressure in a patient > 55 yrs old
  • Accelerated increase in BP
  • Resistant increase in BP
  • Complicated malignant increase in BP
  • Reduction in GFR or rise in Cr with RAS blockade
  • > 1.5 cm difference in renal size on ultrasound
  • Flash pulmonary edema
Class IIa
Class IIb
  • Multivessel CAD or PAD
  • Unexplained CHF or refractory angina

Common causes of Resistant hypertension

Improper blood pressure measurement Volume overload

  • Excess sodium intake
  • Volume retention from kidney disease
  • Inadequate diuretic therapy

Drug-induced or other causes

Less Common Cuases

Complete List of Causes by Organ System

Cardiovascular Aortic regurgitation, Aortic dissection, Acute severe vascular damage, Adams Nance syndrome , Aneurysm, Aortic coarctation , Aortic stenosis, Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly , Arteriosclerosis, Atheroma, Avasthey syndrome , Carotid paraganglioma ,Congenital Mitral stenosis , Eisenmenger's Syndrome , Fibromuscular dysplasia of arteries , Grange syndrome , Hemangiomatosis - familial pulmonary capillary, Hypertensive heart disease , Pulmonary artery agenesis , Vasculitis , Patent ductus arteriosus, Third degree AV block
Chemical / poisoning Acetaldehyde , Aristolochic acid poisoning , Arizona Bark Scorpion poisoning , Black widow spider envenomation , Cadmium poisoning, Cocaine poisoning , Ecstasy abuse , Ginseng , Heavy metal poisoning, Indian Tobacco poisoning, Jimsonweed poisoning , Lead poisoning , Lockwood-Feingold syndrome , Mustard tree poisoning , Nicotine addiction , Pseudoephedrine poisoning , Silicosis , Toxic mushrooms -- Psychedelic , Lobelia poisoning
Dermatologic No underlying causes
Drug Side Effect Almotriptan, Dihydroergotamine, Ergotamine, Frovatriptan, Isometheptene, Rizatriptan, Sumatriptan, Zolmitriptan, Amitriptyline, Cyclosporine, Desipramine, Dexamethasone sensitive hypertension, Doxepin, Ephedrine poisoning, Glucocorticoid resistance , Imipramine, Nasal decongestants, Nortriptyline, Combined oral contraceptive pill, Phencyclidine, Phenylpropanolamine, Protriptyline, Sedative dependence, Serotonin toxicity, Steroid abuse
Ear Nose Throat Nephrosis -- deafness -- urinary tract -- digital malformation , Fitzsimmons-Walson-Mellor syndrome
Endocrine Carcinoid Syndrome, Acromegaly , Adrenal incidentaloma , Alcohol-induced pseudo-Cushing syndrome , Apparent mineralocorticoid excess , Congenital adrenal hyperplasia - 11-Beta-hydroxylase deficiency, Congenital adrenal hyperplasia - 17-alpha-hydroxylase deficiency, Conn's syndrome, Cushing's disease, Cushing's syndrome , Diabetes, Familial Cushing syndrome , Graves Disease , Hyperadrenalism , Hyperparathyroidism , Hyperpituitarism , Hyperthyroidism, Hypothyroidism,Isolated secretion of corticosterone, Isolated secretion of deoxycorticosterone, Mineralocorticoid excess, Multiple endocrine neoplasia type 1, Myxoedema, Pheochromocytoma, Primary aldosteronism, Primary cortisol resistance, Pseudohyperaldosteronism , Pseudohypoaldosteronism , Schroeder syndrome 1 , Hyperthyroidism, Hypoglycemia, Isolated secretion of 18-hydroxy-deoxycorticosterone, Renin-secreting tumors
Environmental No underlying causes
Gastroenterologic Hepatorenal tyrosinemia , Pancreatitis, Retroperitoneal Fibrosis
Genetic Congenital adrenal hyperplasia - 11-Beta-hydroxylase deficiency, Congenital adrenal hyperplasia -17-alpha-hydroxylase deficiency, Cockayne syndrome , Down Syndrome , Fabry's Disease , Isolated secretion of 18-hydroxy-deoxycorticosterone, Pierre Robin's sequence , Senior-Loken Syndrome, Turner Syndrome , Vater-like syndrome with pulmonary hypertension, abnormal ears and growth deficiency , Von Hippel-Lindau Disease , Werner syndrome , Williams Syndrome , Gaucher disease type 3 , Mucopolysaccharidosis type I Hurler syndrome
Hematologic Atypical Hemolytic uremic syndrome, Catastrophic Antiphospholipid Syndrome , Essential mixed Cryoglobulinemia , Faye-Petersen-Ward-Carey syndrome , Hemolytic uremic syndrome , Hypereosinophilic syndrome , Liddle's syndrome, Multicentric Reticulohistiocytosis , Polycythemia , Thromboembolism , Thrombotic thrombocytopenic purpura
Iatrogenic No underlying causes
Infectious Disease Poliomyelitis, Meningitis, Post streptococcal glomerulonephritis , Renal tuberculosis, Nipah virus encephalitis
Musculoskeletal / Ortho Acrodynia , Allain Babin Demarquez syndrome , Familial Osteodysplasia - Anderson type, Paget's disease of bone , Grange syndrome , Faye-Petersen-Ward-Carey syndrome , Oculo skeletal renal syndrome , Thieffry and Sorrell Dejerine syndrome
Neurologic Guillain-Barre Syndrome, Autonomic dysreflexia syndrome , Binswanger's Disease , Brain stem encephalitis, Central sleep apnea , Choroideremia -- hypopituitarism , Disequilibrium syndrome , Dysautonomia , Hereditary sensory and autonomic neuropathy 3 , Increased intracranial pressure, Neurofibromatosis syndrome Type II , Neurogenic hypertension , Nipah virus encephalitis , Obstructive sleep apnea , Sneddon Syndrome , Upper spinal cord lesions, Wolfram's disease, Meningitis, Polyradiculitis, Quadriplegia, Adams Nance syndrome , Glycine encephalopathy - classical neonatal form, Pituitary Cancer , Fitzsimmons-Walson-Mellor syndrome
Nutritional / Metabolic Abdominal obesity metabolic syndrome , Acute intermittent porphyria , Congenital hepatic porphyria , Gaucher disease type 3, Glycine encephalopathy - classical neonatal form, Glycine synthase deficiency , Gouty nephropathy, Metabolic syndrome, Tyrosinemia , Von Gierke disease IB, Increased salt intake, Mucopolysaccharidosis type I Hurler syndrome, Fabry's Disease
Obstetric/Gynecologic Eclampsia , Fowler-Christmas-Chapple syndrome , Gestational hypertension, HELLP syndrome , Ovarian dysgenesis, PCOS, Pregnancy toxemia /hypertension , Twin-Twin Transfusion Syndrome
Oncologic Endothelin producing tumor, Adrenal Cancer , Familial Adrenal adenoma , Renal Cancer , Neuroblastoma

Pituitary Cancer , Renin-secreting tumors, Rhabdoid tumor , Wilms' tumor , Adrenal incidentaloma , Familial Renal cell carcinoma

Opthalmologic Isolated Ectopia lentis, Oculo skeletal renal syndrome
Overdose / Toxicity Amphetamine abuse
Psychiatric Anxiety
Pulmonary Asphyxia , Bronchopulmonary dysplasia, COPD , Goodpasture syndrome , Pulmonary cystic lymphangiectasis , Pulmonary embolism , Pulmonary fibrosis /granuloma , Pulmonary veno-occlusive disease , Pulmonary Lymphangiomatosis, Respiratory acidosis , Respiratory failure , Unilateral pulmonary agenesis , Hyperventilation, Obstructive sleep apnea , Wegener's granulomatosis
Renal / Electrolyte Bartter's Syndrome, Dissection of the renal arteries, Acid-Base Imbalance , Acute Renal Failure , Albuminuria , Analgesic nephropathy syndrome , Autosomal dominant Polycystic kidney disease , Autosomal Recessive Polycystic Kidney Disease , Bilateral Renal artery stenosis , Bright's Disease , Chronic kidney disease , Chronic pyelonephritis, Congenital Membranous glomerulonephritis, Congenital stenosis of renal artery, Congenital Hydronephrosis , Diffuse Mesangial sclerosis, Familial Renal cell carcinoma , Fitzsimmons-Walson-Mellor syndrome , Glomerulonephritis , Hereditary nephritis (X-linked), Hypoplastic kidney, IgA nephropathy , Kidney arteriovenous fistula , Kimmelstiel-Wilson disease, Lupus nephritis , Nephrocalcinosis , Nephrosclerosis , Nephrosis -- deafness -- urinary tract -- digital malformation , Nephrotic syndrome , Oculo skeletal renal syndrome , Pierson syndrome , Severe infantile Polycystic kidneys with Tuberous sclerosis , Post streptococcal glomerulonephritis , Renal artery thrombosis, Renal emboli, Renal segmental hypoplasia-induced Hypertension , Renal tuberculosis, Salcedo syndrome , Simple kidney cysts , Thieffry and Sorrell Dejerine syndrome , Urinary tract infections , Urinary tract obstruction, Vesicoureteral reflux , Wegener's granulomatosis , Gitelman's Syndrome, Hepatorenal tyrosinemia , Atypical Hemolytic uremic syndrome, Gouty nephropathy, Goodpasture syndrome
Rheum / Immune / Allergy Autoimmune Vasculitis , Systemic lupus erythematosus, Diffuse Systemic sclerosis , Polyarteritis nodosa , , Takayasu arteritis
Sexual No underlying causes
Trauma Electrical burns , Head injury, Skull fracture
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Acquired total Lipodystrophy , After Kidney transplantation, Age, Alcohol withdrawal, Amyloidosis , Bone cement implantation syndrome , Brachydactyly with hypertension, Carnevale-Canun-Mendoza syndrome , Codeine withdrawal , Collagen disease, Essential hypertension, Gram's syndrome , Hypothermia, Irradiation, Kashani-Strom-Utley syndrome , Lymphomatoid Granulomatosis , MSBD syndrome , Neuroleptic Malignant Syndrome , Obesity, Physical inactivity , Selye syndrome , Serotonin Syndrome , Shaken Baby Syndrome , Stress-Induced Hypertension , Type A personality, Vitamin D -- adverse effects, Wagener syndrome , Pain, Post-exercise, Transfusion of large blood volumes, White coat hypertension

Causes in Alphabetical Order


References

  1. isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:85
  2. isbn=1591032016 Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194-195
  3. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD; et al. (2008). "Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research". Hypertension. 51 (6): 1403–19. doi:10.1161/HYPERTENSIONAHA.108.189141. PMID 18391085.
  4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289 (19): 2560–72. doi:10.1001/jama.289.19.2560. PMID 12748199.
  5. J Vasc Interv Rad 2006 17:1383-1398

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