What are the causes of sudden onset of hypertension?

From the Guidelines

Sudden onset hypertension is most commonly caused by conditions such as kidney disease, endocrine disorders, and neurological conditions, which require prompt medical attention to prevent target organ damage. The causes of sudden onset hypertension can be multifactorial, including:

• Medication side effects, particularly from NSAIDs, decongestants, steroids, or certain antidepressants
• Kidney disease, especially renal artery stenosis, as indicated by elevated serum creatinine, proteinuria, or haematuria 1
• Endocrine disorders, such as pheochromocytoma, Cushing's syndrome, or primary aldosteronism
• Neurological conditions, including increased intracranial pressure
• Recreational drug use, particularly cocaine or amphetamines
• Pregnancy-related conditions like preeclampsia
• Severe pain or anxiety
• Certain foods and substances containing tyramine or excessive sodium
• Abrupt discontinuation of antihypertensive medications like clonidine or beta-blockers

According to the 2020 international society of hypertension global hypertension practice guidelines, a hypertensive emergency is defined as the association of substantially elevated BP with acute target organ damage, which requires rapid diagnostic workup and immediate BP reduction to avoid progressive organ failure 1. Identifying and addressing the root cause of sudden onset hypertension is essential for effective management and prevention of target organ damage. Treatment depends on the underlying cause but may include medication adjustments, lifestyle modifications, or specific interventions targeting the primary condition. Anyone experiencing sudden high blood pressure should seek immediate medical care, especially if accompanied by symptoms like severe headache, vision changes, chest pain, or difficulty breathing.

From the FDA Drug Label

WARNINGS Withdrawal Patients should be instructed not to discontinue therapy without consulting their physician. Sudden cessation of clonidine treatment has, in some cases, resulted in symptoms such as nervousness, agitation, headache, and tremor accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma Because children commonly have gastrointestinal illnesses that lead to vomiting, they may be particularly susceptible to hypertensive episodes resulting from abrupt inability to take medication.

The causes of sudden onset of hypertension mentioned in the label are:

• Sudden cessation of clonidine treatment 2
• Abrupt inability to take medication, such as due to vomiting in children 2

From the Research

Causes of Sudden Onset of Hypertension

The causes of sudden onset of hypertension can be categorized into primary and secondary hypertension.

• Primary hypertension has no clear etiology, while secondary hypertension indicates an underlying and potentially reversible cause 3.
• The most common causes of secondary hypertension in children are renal parenchymal disease and coarctation of the aorta, whereas in adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes 3.
• Other underlying causes of secondary hypertension include:
  • Hyperaldosteronism
  • Obstructive sleep apnea
  • Pheochromocytoma
  • Cushing syndrome
  • Thyroid disease
  • Coarctation of the aorta
  • Use of certain medications 3
• Hypertensive crisis, which is a sudden and abrupt elevation in blood pressure, can be caused by various factors, including renovascular hypertension, and should be considered in patients with severe or resistant hypertension, or an acute rise in blood pressure from previously stable readings 3, 4.
• Intermittent blood pressure control can also lead to sudden onset of hypertension, particularly with certain antihypertensive drugs such as rapid onset and short duration of action drugs 5.
• Primary hyperaldosteronism is a leading cause of secondary hypertension, particularly in individuals who develop hypertension at an early age, and can cause sudden onset of hypokalemia in a hypertensive patient 6.
• Pheochromocytoma is a rare tumor that can cause hypertension due to the secretion of catecholamines, and appropriate antihypertensive drugs are used to manage hypertension and prepare patients for operation 7.