From the Guidelines
Secondary hypertension is caused by several identifiable conditions, including genetic causes of hypertension, excess liquorice, Cushing’s syndrome, thyroid disease, hyper-parathyroidism, aortic coarctation, and acromegaly, as stated in the ESC 2024 guidelines 1. The main causes of secondary hypertension can be categorized into several groups, including:
- Renal causes, such as renal parenchymal disease and renovascular disease
- Endocrine causes, such as primary aldosteronism, pheochromocytoma, Cushing's syndrome, and hyperparathyroidism
- Other causes, such as obstructive sleep apnea, coarctation of the aorta, thyroid disorders, and certain medications or substances According to the ESC 2024 guidelines, other forms of secondary hypertension, such as genetic causes of hypertension, excess liquorice, Cushing’s syndrome, thyroid disease, hyper-parathyroidism, aortic coarctation, and acromegaly, are rare, but affected patients should be referred to specialized centers for treatment 1. It is essential to identify the underlying cause of secondary hypertension, as treating the primary condition can potentially cure the hypertension or significantly improve blood pressure control, which can have a significant impact on morbidity, mortality, and quality of life 1. Some of the key causes of secondary hypertension, as outlined in the guidelines, include:
- Primary aldosteronism, which accounts for approximately 5-10% of all hypertension cases and is characterized by autonomous aldosterone production leading to sodium retention and potassium excretion
- Renal causes, which collectively represent about 20-30% of secondary hypertension cases, with renal parenchymal disease being more common than renovascular disease
- Endocrine causes, such as pheochromocytoma, which are rarer but clinically significant due to their potential for causing severe, episodic hypertension
- Drug-induced hypertension, which is increasingly recognized, with common culprits including NSAIDs, oral contraceptives, sympathomimetics, immunosuppressants like cyclosporine, and certain antidepressants.
From the Research
Causes of Secondary Hypertension
The causes of secondary hypertension include:
- Renal parenchymal disease 2, 3, 4, 5, 6
- Renovascular diseases 2, 3, 4, 5
- Coarctation of the aorta 2, 4, 5
- Cushing's syndrome 2, 3, 4, 5
- Primary hyperaldosteronism 2, 3, 4, 5
- Pheochromocytoma 2, 3, 4, 5, 6
- Hyperthyroidism 2, 5
- Hyperparathyroidism 2, 4, 5
- Medication-induced hypertension 3
- Obstructive sleep apnea 3, 4, 5
- Hypothyroidism 5
- Use of certain medications 5
Diagnosis of Secondary Hypertension
Features that aid in the diagnosis of secondary hypertension include:
- 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 2
- Resistant or refractory hypertension 2, 4, 5
- Specific biochemical tests that suggest the existence of certain disorders 2
- Abdominal diastolic bruits, decreased femoral pulses, or bitemporal hemianopias 2
- Snoring or clear sleep apnea 4
- Rapid rise in blood pressure values in previously well-controlled patients 4
- Severe hypertension (>180/110 mmHg), malignancy, or hypertensive emergencies 4