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Secondary hypertension (or, less commonly, inessential hypertension) is a type of hypertension which by definition is caused by an identifiable underlying secondary cause. It is much less common than the other type, called essential hypertension, affecting only 5% of hypertensive patients. It has many different causes including endocrine diseases, kidney diseases, and tumors. It also can be a side effect of many medications.

Types

Renovascular hypertension (I15.0)

It has two main causes: fibromuscular dysplasia and atheromatous stenosis.

• See main article at Renovascular hypertension.

Hypertension secondary to other renal disorders (I15.1)

• Chronic renal failure
• Kidney disease / renal artery stenosis: the normal physiological response to low blood pressure in the renal arteries is to increase cardiac output (CO) to maintain the pressure needed for glomerular filtration. Here, however, increased CO cannot solve the structural problems causing renal artery hypotension, with the result that CO remains chronically elevated.
• Renal segmental hypoplasia (Ask-Upmark kidney)

Hypertension secondary to endocrine disorders (I15.2)

• Pheochromocytoma

-caused by an excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction.

• Hyperaldosteronism (Conn's syndrome)

- idiopathic hyperaldosteronism, liddle's syndrome( also called pseudoaldosteronism), glucocorticoid remediable aldosteronism.

• Cushing's syndrome-an excessive secretion of glucocorticoids causes the hypertension.
• Hyperparathyroidism
• Acromegaly
• Hyperthyroidism
• Hypothyroidism
• vascular damage. - coarctation of aorta, atherosclerosis of aorta.

Other secondary hypertension (I15.8)

• Hormonal contraceptives
• Neurologic disorders
• Obstructive sleep apnea
• Liquorice (when consumed in excessive amounts)
• Scleroderma
• Neurofibromatosis
• Pregnancy: unclear etiology.
• Cancers: tumours in the kidney can operate in the same way as kidney disease. More commonly, however, tumors cause inessential hypertension by ectopic secretion of hormones involved in normal physiological control of blood pressure.
• Drugs: In particular, alcohol, nasal decongestants with adrenergic effects, NSAIDs, MAOIs, adrenoceptor stimulants, and combined methods of hormonal contraception (those containing ethinyl-estradiol) can cause hypertension while in use.
  • Heavy alcohol use
  • Steroid use
• Malformed aorta, slow pulse: these cause reduced blood flow to the renal arteries, with physiological responses as already outlined.
  • Aortic valve disease: unclear etiology.
  • Coarcation of the aorta
• Anemia: unclear etiology.
• Fever: unclear etiology.

Diagnosis

The ABCDE mnemonic can be used to help determine a secondary cause of hypertension

• A: Accuracy, Apnea, Aldosteronism
• B: Bruits, Bad Kidney
• C: Catecholamines, Coarctation of the Aorta, Cushing's Syndrome
• D: Drugs, Diet
• E: Erythropoietin, Endocrine Disorders ^[1]

References

External links

• CVPhysiology
• CNN
• Mayo Clinic
• Hypertension Types