From the Guidelines
Non-renal causes of hypertension include lifestyle factors, genetics, and certain medical conditions, such as endocrine disorders, sleep apnea, and medication use, as outlined in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The main causes of non-kidney related hypertension can be broken down into several categories:
- Lifestyle factors:
- High salt intake
- Obesity
- Lack of physical activity
- Excessive alcohol consumption
- Chronic stress
- Genetic factors: can predispose some individuals to developing hypertension
- Other medical conditions:
- Endocrine disorders (e.g., thyroid problems, adrenal gland tumors)
- Sleep apnea
- Certain medications (e.g., oral contraceptives, NSAIDs) To address these causes, lifestyle modifications are often the first line of treatment, including reducing salt intake, maintaining a healthy weight, exercising regularly, limiting alcohol, and practicing stress-reduction techniques 1. If lifestyle changes are insufficient, medication may be prescribed, with common options including:
- ACE inhibitors (e.g., lisinopril)
- Angiotensin receptor blockers (e.g., losartan)
- Calcium channel blockers (e.g., amlodipine)
- Diuretics (e.g., hydrochlorothiazide) These medications work by either reducing blood volume, relaxing blood vessels, or decreasing heart rate to lower blood pressure, as noted in the guideline 1. The choice of medication depends on individual factors and potential side effects, and understanding the non-renal causes of hypertension is crucial for developing targeted treatment strategies to effectively manage the condition and reduce the risk of associated complications like heart disease and stroke 1.
From the Research
Non-Renal Causes of Hypertension
The non-renal causes of hypertension include:
- Coarctation of the aorta 2, 3, 4
- Cushing's syndrome 2, 5, 6, 4
- Primary hyperaldosteronism 2, 5, 3, 6, 4
- Pheochromocytoma 2, 5, 3, 6, 4
- Hyperthyroidism 2, 3, 4
- Hyperparathyroidism 2
- Hypothyroidism 3, 4
- Obstructive sleep apnea 3, 6, 4
- Use of certain medications such as oral contraceptives, non-steroidal anti-inflammatory drugs, sympathomimetics, adrenal steroids, and antineoplastic drugs targeting the vascular endothelial growth factor (VEGF) pathway 6, 4
Characteristics that Suggest Non-Renal Causes of Hypertension
Certain characteristics may suggest the presence of non-renal causes of hypertension, including:
- Onset of hypertension before the age of 20 or after the age of 50 years 2
- Markedly elevated blood pressure or hypertension with severe end-organ damage 2
- Specific body habitus and ancillary physical findings, such as truncal obesity and purple striae in Cushing's syndrome 2
- Resistant or refractory hypertension 2, 3, 6
- Specific biochemical tests that suggest the existence of certain disorders, such as hypercalcemia in hyperparathyroidism or hyperglycemia in Cushing's syndrome 2