Renal disease is the most common cause of secondary hypertension. Secondary hypertension is the presence of a specific condition known to cause hypertension. In young adults of secondary hypertension is approximately 30%. It has many different causes including endocrine diseases. Doctors suspect a link between hypertension, or high blood pressure, and diabetes, and each condition can make the other worse. Read on to find out what causes hypertension, its symptoms, types, and how to prevent it. Causes of hypertension in neonates as in older infants and children, the causes of hypertension in neonates are numerous table i. Secondary hypertension is attributable to an underlying medical disorder. See box 351 for factors that suggest the presence of secondary hypertension, and table 352 for etiologies and screening techniques. Currently this means that no specific cause is identified for the condition. However, the decision to do surgery is often guided by the age and general health of the patient.
A thorough medical history and physical examination can often give clues as. The most common cause of secondary htn is associated with kidney impairment such as chronic kidney disease ckd or renovascular disease. Hypertension due to secondary causes is less likely to be seen in elderly individuals. Hypertension is the single biggest contributor to the global burden of disease, and is the most common chronic medical condition presenting to primary care physicians in singapore. What is the most common cause of secondary hypertension high. About 6% of the time, however, high blood pressure is caused by another condition or disease. Jul 22, 2019 secondary hypertension has specific causes and is a complication of another health problem. It is important to diagnose and treat secondary causes of hypertension, as it can lead to cardiovascular and renal complications as well as increased healthcare costs if left undiagnosed. Secondary hypertension secondary causes of hypertension tab. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good. What is secondary pulmonary hypertension caused by. Secondary hypertension is elevated blood pressure that results from an underlying, iden tifiable, often. Only 510% of patients suffering from arterial hypertension have a secondary form, whereas the vast majority has essential idiopathic or primary hypertension.
Mar, 2019 secondary hypertension can be caused by conditions that affect your kidneys, arteries, heart or endocrine system. A secondary etiology may be suggested by symptoms e. Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. When this happens, it is called secondary hypertension. A thorough medical history and physical examination can often give clues as to the presence of secondary causes of hypertension. Causes of secondary hypertension with clinical indications and diagnostic screening tests 1 of 3 8. For some patients, antihypertensive medications may be a safer option than. The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure. Secondary hypertension symptoms and causes mayo clinic. The other common cause of secondary hypertension in older adults is renal insufficiency from any of many causes. See nices patient decision aid for hypertension see next page for choice of drug, monitoring and bp targets. Primary hypertension has no clear cause and is thought to be linked to genetics, poor diet, lack of exercise and obesity. Underlying causes of hypertension were found in 297 patients 7. Essential hypertension is the presence of sustained hypertension in the absence of underlying, potentially correctable kidney, adrenal or other factors.
Estimating the pretest probability of a secondary identifiable cause of hypertension is problematic, because referral bias is a major problem in hypertension prevalence studies. Early onset hypertension up to 85% of preadolescent children with hypertension have secondary cause most commonly renal parenchymal disease gn, congenital, reflux nephropathy may not present until adolescentyoung adult consider adding urine culture and renal ultrasonography as part of routine. Jun 06, 2019 the treatment of secondary hypertension depends on its cause. Meets criteria for htnmeets criteria for htn results from an identifiable, potentially correctable cause accounts for significant number of resistant htn cases estimated to account for 515% of cases of htn prevalence of hypertension in adults between 2030% 5070 million people. May 28, 2019 doctors suspect a link between hypertension, or high blood pressure, and diabetes, and each condition can make the other worse. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn in adults aged. Both can lead to severe, lifealtering, and possibly fatal consequences. Outside the scope of this guideline is the management of secondary causes of htn, accelerated htn, acute htn in emergency. Chronic kidney disease ckd is a common cause of high blood pressure, as the kidneys no longer filter. This condition may be the sole cause for hypertension in an individual, or a contributing factor in a patient who already has primary hypertension.
In young patients, renal causes glomerulonephritis and coarctation of the aorta should be considered. Mar 02, 2011 druginduced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. The patients medical history was notable for noncontrolled hypertension and oslerweberrendu disease, while his current medication included lercanidipine 20 mg. Whom should you test for secondary causes of hypertension. Diagnosis of secondary hypertension with investigations nursing diagnosis for high blood pressure secondary hypertension differential diagnosis diagnosis high blood pressure age of patients of secondary hypertension may be 50 years. Secondary hypertension or, less commonly, inessential hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. Secondary hypertension differs from the usual type of high blood pressure primary hypertension or essential hypertension, which is often.
Hypertension is estimated to affect up to 65 million adults in the usa. The number of cases secondary to renal and adrenal lesions has increased, with a corresponding reduction in the number of patients relegated to the category of essential hypertension. Previously considered a rare cause of hypertension, pa is now recognized to be the most common cause of secondary hypertension. Jul 11, 2017 when a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension.
Specialist investigations for possible secondary causes of hypertension. Of the secondary causes of hypertension, primary aldosteronism, pheo and rvht are the hypertensive syndromes most commonly encountered in clinics. Secondary hypertension is defined as increased systemic blood pressure bp due to an identifiable cause. Feb 27, 2020 essential hypertension primary, cause unknown accounts for the majority of cases, particularly in the older patient.
The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure control since many forms of secondary hypertension cause treatmentresistant hypertension. Patients likely to have essential idiopathic or primary hypertension undergo a relatively limited. Preadolescent children with hypertension should be evaluated for possible secondary hypertension. The chief causes of secondary hypertension are renal artery stenosis, primary aldosteronism, and, more recently, excess adrenal secretion of 18. Secondary hypertension is elevated blood pressure bp, which is secondary to an identifiable cause. When secondary hypertension results from a tumor or a blood vessel abnormality, surgery may be recommended. An attempt to detect secondary causes of hypertension is important due to the potential for cure with appropriate treatment. Several drugs can induce or exacerbate preexisting hypertension, with nonsteroidal antiinflammatory drugs being the most common due to their wide use. The secondary causes of hypertension include renal causes e. More sih causes are thought to exist, but research is needed to confirm whether there are true relationships. A range of risk factors may increase the chances of a person developing hypertension, but can it be prevented. The different causes of secondary pulmonary hypertension include autoimmune diseases such as rheumatoid arthritis and sle, connective tissue diseases scleroderma, crest syndrome, lupus, liver diseases, congenital heart diseases atrial and ventricular septal defects, sickle cell anemia, hiv infection and schistosomiasis parasitic infection.
Try the dietary approaches to stop hypertension dash diet, which emphasizes fruits, vegetables, whole grains and lowfat dairy foods. Fewer than 10% of patients have secondary hypertension. Dermatological complains were promptly managed, a complete cardiovascular risk stratification was performed and. It is much less common than the other type, called essential hypertension, affecting only 5% of hypertensive patients. Hypertension diagnosis and management effective date. Common secondary causes of resistant hypertension and. In kids who are less than 12 years old, most hypertension is secondary and from renal parenchymal disease. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Secondary causes of resistant hypertension hypertension. Both idiopathic and secondary intracranial hypertension can cause the same physical symptoms of raised intracranial pressure and can become chronic. In phaeochromocytoma there is anxiety, headache, weight loss, hyperglycemia. Secondary hypertension has specific causes and is a complication of another health problem. Although lowering secondary hypertension can be difficult, making the same lifestyle changes you would make if you had primary high blood pressure can help.
Most people with high blood pressure are diagnosed with essential hypertension. Secondary hypertension differs from the usual type of high blood pressure primary hypertension or essential hypertension, which is often referred to simply as high blood pressure. Jun 06, 2018 the different causes of secondary pulmonary hypertension include autoimmune diseases such as rheumatoid arthritis and sle, connective tissue diseases scleroderma, crest syndrome, lupus, liver diseases, congenital heart diseases atrial and ventricular septal defects, sickle cell anemia, hiv infection and schistosomiasis parasitic infection. Consider the need for specialist investigations in people with signs and symptoms suggesting a secondary cause of hypertension. Hypertensive nephrosclerosis, which causes renal dysfunction on the basis of essential hypertension, and diabetic nephropathy are discussed in. What is the most common cause of secondary hypertension. This may be intrinsic renal disease glomerulonephritis. Hypertension may be the initial clinical presentation for at least 15 endocrine disorders. This form of high blood pressure tends to appear suddenly and often causes higher blood pressure than primary htn 1,2,5. Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects.
Secondary hypertension in adults pubmed central pmc. In most of these cases renal dysfunction resulting from sever chronic kidney disease or renovascular disease is the most common secondary cause. Learn more from webmd about the causes and treatment of secondary. Diagnosis and investigations of secondary hypertension.
While the majority of patients have essential hypertension that does not have an identifiable cause, it is important to recognise secondary causes of hypertension table i, as. I read with interest the article by salles and colleagues. Secondary hypertension in a blood pressure clinic jama. Secondary hypertension is commonly caused by renal disease, endocrine conditions or pregnancy. The prevalence, reversibility, and mortality of secondary hypertension among 3783 patients with moderately severe nonmalignant hypertension attending the glasgow scotland blood pressure clinic were assessed. High blood pressure might be the result of a secondary condition, such as sleep apnea, kidney problems, or even pregnancy. The diagnosis of essential and secondary hypertension in.
Coexistence of hypertension and related chronic conditions 11. A classification of secondary causes is shown in table 1. Identifying the population at risk is the initial step in the diagnostic process. Hypertension is either essential or secondary see table 86.
Jul 14, 2011 patients with uncontrolled hypertension in spite of optimal, intensive medical management. Secondary hypertension occurs in a significant proportion of adult patients 10%. Secondary hypertension differs from the usual type of high blood pressure primary hypertension or essential hypertension, which is often referred to simply as high blood. Hypertensionprimary and secondary annals of internal.
The evidence for selecting which patients should undergo additional testing for potentially correctable secondary causes of hypertension is based on the prevalence of these causes in different age groups, case series of reversal of hypertension with effective treatment of the underlying cause, and clinical suspicion of a secondary cause that may be reversible. This rare cause of secondary hypertension illustrates the importance of a methodical approach to the assessment of hypertension. His physical examination was notable for a blood pressure of 156104 mmhg and a body mass index of 25 kgm2. Secondary hypertension diagnosis and treatment mayo clinic. Secondary hypertension can also occur during pregnancy. Druginduced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension.
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