From the Guidelines
Secondary hypertension is most commonly caused by renal parenchymal disease, renovascular hypertension, primary aldosteronism, chronic sleep apnea, and substance/drug-induced hypertension, as identified in 5%–10% of hypertensive patients 1. The most recent and highest quality study, the 2020 international society of hypertension global hypertension practice guidelines, highlights the importance of early diagnosis and targeted treatment of secondary hypertension to potentially cure hypertension or improve blood pressure control 1.
Common Causes of Secondary Hypertension
- Renal parenchymal disease
- Renovascular hypertension
- Primary aldosteronism
- Chronic sleep apnea
- Substance/drug-induced hypertension Other causes of secondary hypertension, as outlined in the 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline, include:
- Pheochromocytoma/paraganglioma
- Cushing’s syndrome
- Hypothyroidism
- Hyperthyroidism
- Aortic coarctation (undiagnosed or repaired)
- Drug or alcohol induced hypertension It is essential to identify and treat the underlying cause of secondary hypertension, as addressing the primary condition can often normalize blood pressure without long-term antihypertensive medication 1.
Clinical Indications and Diagnostic Screening Tests
The 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline provides a comprehensive overview of clinical indications and diagnostic screening tests for various causes of secondary hypertension, including renal parenchymal disease, renovascular disease, primary aldosteronism, and obstructive sleep apnea 1. Early diagnosis and targeted treatment of secondary hypertension can significantly improve patient outcomes, reducing morbidity, mortality, and enhancing quality of life 1.
From the Research
Secondary Causes of Hypertension
The secondary causes of hypertension are identifiable and potentially correctable conditions or diseases that lead to high blood pressure. Some of the common causes include:
- Renovascular disease
- Renal parenchymal disease
- Primary hyperaldosteronism
- Drug and substance use
- Obstructive sleep apnea Less common etiologies include:
- Pheochromocytoma/paraganglioma
- Cushing syndrome
- Thyroid and parathyroid conditions
- Congenital adrenal hyperplasia
- Aortic coarctation 2
Prevalence of Secondary Hypertension
Secondary hypertension occurs in approximately 5% to 10% of all patients with hypertension 2, 3. It is more common in patients with resistant forms of hypertension 4.
Diagnosis and Treatment
Early recognition of suggestive clinical findings and laboratory results enables the timely diagnosis of specific secondary causes of hypertension 2. The diagnosis of secondary hypertension involves selecting patients for testing based on historical and clinical clues, previous treatment course, and comorbidities 5. Treatment is specific to the underlying cause and includes medications, procedures, surgery, and device therapies 3.
Common Causes of Secondary Hypertension
Recent studies have pointed out that the most common causes of secondary hypertension are those that do not promote hypertension remission, including: