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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 of the time, secondary hypertension is caused by problems with the adrenal glands or the arteries supplying the kidneys. Diagnosing and treating the underlying condition often improves or even resolves a person’s elevated blood pressure... "There are four main groups of people in whom you might suspect secondary hypertension as a possibility," says Dr. Randall Zusman, director of the Division…

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 Secondary hypertension, hyperaldosteronism, Cushing’s, and pheochromocytoma

Expert tips on the diagnosis and management of secondary hypertension in this conversation with Dr. Richard Auchus MD, PhD, Professor of Pharmacology and Internal Medicine & Director of the Diabetes, Endocrinology, & Metabolism Fellowship Program at the University of Michigan. Topics include: primary hyperaldosteronism, use of spironolactone, Cushing’s syndrome, pheochromocytoma, and which tests to utilize.

Articles of Interest

Diagnosis of Secondary Hypertension: An Age-Based Approach

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.

Secondary arterial hypertension: when, who, and how to screen?

Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects ∼5–10% of the general hypertensive population. Because secondary forms are rare and work up is time-consuming and expensive, only patients with clinical suspicion should be screened.

Secondary Hypertension: Discovering the Underlying 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.

Secondary Hypertension: Just as Essential as Primary

A specific, remediable cause of hypertension can be identified in approximately 10% of adult patients with hypertension. If a cause can be correctly diagnosed and treated, patients with secondary hypertension can achieve a cure or experience a marked improvement in BP control, with reduction in cardiovascular disease risk - Whelton et al. J Am Coll Cardiol. 2018.

Adult Secondary Hypertension: What the Primary Care Provider Needs to Know

Although only a minority of patients with hypertension have secondary causes for it, identifying these patients is crucial, because treatment of the root cause may resolve or improve control of hypertension and improve long-term outcomes.

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StatPearls

Secondary hypertension is defined as elevated blood pressure (BP) secondary to an identifiable cause. The prevalence of secondary hypertension varies with age and it is most prevalent at the extremes of age. It accounts for 70 to 85 percent of hypertension cases in children less than 12 years of age, and approximately 17 percent of cases in adults aged 65 and older.