Approach to a case of secondary hypertension sciencedirect. It is much less common than the other type, called essential hypertension, affecting only 510% of hypertensive patients. In most of these cases renal dysfunction resulting from sever chronic kidney disease or renovascular disease is the most common secondary cause. To accomplish this, the society established the writing group of the american society of hypertension wgash, chaired by dr. Renal parenchymal hypertension, caused by renal parenchymal disorders, is a common form of secondary hypertension, accounting for 25% of. Prevalence of essential hypertension increases with age, and individuals. While the majority of patients have essential hypertension that does not have an identifiable cause, it is important to recognise secondary causes of hypertension table i, as. Secondary hypertension develops at an early age or. Resistant hypertension is important to recognise because it places patients at. Postmenopausal estrogen does not generally cause hypertension, but rather maintains endotheliummediated vasodilation. Secondary hypertension is systemic hypertension due to an underlying disorder. In order to treat secondary hypertension, your doctor will address the condition or disorder that is causing the hypertension adrenal gland disorder, kidney disease, sleep apnea, etc. Verapamil mostly works on cardiac muscle, slows entry of calcium during phases 2 and 3 of the cardiac action potential.
Intuitively, it seems most appropriate to continue to combine agents of. Until recently, there has been an optimistic view that description of new causes of hypertension would mean that those regarded as having essential hypertension would be an everdiminishing group. Secondary hypertension or, less commonly, inessential hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. Secondary hypertension, issues in diagnosis and treatment article pdf available in primary care clinics in office practice 414 december 2014 with 152 reads how we measure reads. Research article open access current perspectives in the. Therefore, when assessing accelerated or poorly controlled blood pressures, one should always. If that is the case, it is called secondary hypertension.
See box 351 for factors that suggest the presence of secondary hypertension, and table 352 for etiologies and screening techniques. Read on to find out what causes hypertension, its symptoms, types, and how to prevent it. For some patients, antihypertensive medications may be a safer option than. Secondary hypertension occurs in a significant proportion of adult patients 10 %.
Secondary hypertension in adults pubmed central pmc. Preadolescent children with hypertension should be. In most people, the actual cause of their hypertension is not known. When secondary hypertension results from a tumor or a blood vessel abnormality, surgery may be recommended. Diltiazem affects cardiac smooth muscle, causes mild decrease in svr, bp and co.
Secondary causes of hypertension are common in patients with resistant hypertension. A number of other medications may cause or exacerbate hypertension most importantly cyclosporine and nsaids. Now, just 2 years after publication of jnc7, the american society of hypertension ash has realized a need to revise their definition of hypertension and recommendations for its recognition and treatment. Effects of ace inhibitors, calcium antagonists, and other bloodpressurelowering drugs. Patients likely to have essential idiopathic or primary hypertension undergo a relatively limited evaluation because extensive laboratory. Primary hypertension has no clear cause and is thought to be linked to genetics, poor diet, lack of exercise and obesity. The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure control since many forms of secondary hypertension cause treatmentresistant hypertension. Hypertension causes and treatment flashcards quizlet. Secondary hypertension is less common and is usually the result of another condition, which include disorders of the adrenal gland, including cushings syndrome a condition caused by an overproduction of cortisol, hyperaldosteronism too much aldosterone and pheochromocytoma a rare tumor that causes over secretion of hormones like adrenaline.
Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. The 20 joint european society of hypertension esh and the european society of cardiology esc guidelines recommend that ambulatory bloodpressure monitoring abpm be incorporated into the assessment of cardiovascular risk factors and hypertension. It has many different causes including endocrine diseases, kidney diseases, and tumors. The other set of 5% of hypertensive cases are termed secondary hypertension for which specific causes for the bp elevation can be identified for example, renal parenchymal disease, renal artery stenosis, primary hyperaldosteronism, cushing syndrome or phaeochromocytoma, or sleep apnea. When to implement lifestyle management recommended for mild hypertension average bp 1401599099, lowrisk for cvd and have no comorbidities. Hypertension is the medical term for high blood pressure. Young age, severe hypertension, family history, and signs and symptoms of syndromes associated with hypertension are suggestive of an underlying secondary cause for elevated bp. Examples of secondary causes of hypertension indications for a secondary cause of hypertension are. A secondary etiology may be suggested by symptoms e.
Hypertension is the leading cause of strokes and heart attack. The term secondary hypertension is used to describe patients whose blood pressure is elevated by a single, identifiable cause. The importance of potassium in managing hypertension. Hypertension due to secondary causes is less likely to be seen in elderly individuals. It is one of the most prevalent conditions seen today by researchers in both developed and underdeveloped countries. Druginduced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Secondary hypertension has specific causes and is a complication of. How do i investigate suspected secondary hypertension. In about 10% of people, high blood pressure is caused by another disease. Hypertension is the single biggest contributor to the global burden of disease, and is the most common chronic medical condition presenting to primary care physicians in singapore.
John warner, md, president of the american heart association, interviews paul whelton, md, writing group chair for the 2017 hypertension clinical practice guidelines and the need for the guidelines, the new classification system, and what it means for clinicians and their patients. Prevention of high blood pressure is recognized as the controlling key to hypertension. The pathophysiology of hypertension is an area which attempts to explain mechanistically the causes of hypertension, which is a chronic disease characterized by elevation of blood pressure. Impact of treating hypertension moser m, hebert pr.
Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. Hypertension htn or ht, also known as high blood pressure hbp, is a longterm medical condition in which the blood pressure in the arteries is persistently elevated. Following are the causesf uncontrolled hypertension 1not able to afford the medicine and healthcare not available, lack of insurance 2 non compliant with treatment and meds 3renal artery stenosis. It may be a consequence of secondary hypertension or have no identifiable cause. Hypertension is one of the most important preventable causes of premature morbidity and. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled. Primary hypertension accounts for approximately 90%95% of all cases of hypertension. The overall prevalence of hypertension is around 3045% in the adult population at large in europe. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Review the 2014 evidencebased guidelines for the management of hypertension in adults for patients aged 60 years or more.
Secondary hypertension symptoms and causes mayo clinic. Renal parenchymal diseasesprimary aldosteronismcushings syndromepheochromocytoma. The cause of hypertension is not yet known unless it is unless is secondary high. Longterm high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral arterial disease, vision. Secondary hypertension is associated with more severe elevation in bp and, hence. The lowest recorded bp at the most recent a office visit with internal medicine, family medicine, endocrinology, cardiology, and nephrology or. Pathophysiology is a branch of medicine which explains the function of the body as it relates to diseases and conditions. The general practitioner has a primordial role in the prevention of hypertension, mainly achieved by healthy lifestyle, in the early identification of hypertension and in the management of an elevated blood pressure bp by both lifestyle. Secondary hypertension occurs in a significant proportion of adult patients 10%. The key in the addition of second, third or more drugs is to combine agents with different mechanisms of. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good. Slows av node conduction so used for atrial flutter. Pdf secondary hypertension, issues in diagnosis and. Secondary hypertension differs from the usual type of high blood pressure primary hypertension or essential hypertension, which is often referred to simply as high blood pressure.
In young patients, renal causes glomerulonephritis and coarctation of the aorta should be considered. It is always important to exclude secondary causes for the hypertension. Lastly, the kidneys are injured by longstanding hypertension and this is a significant cause of renal failure in the u. Hypertension can be classified by cause as either essential also known as primary or. Secondary hypertension is more common in children compared with adults who predominantly have primary hypertension. New guidelines for the management of hypertension is the. Clinical practice guidelines for the management of hypertension in the community a statement by the american society of hypertension and the. Primary hypertension accounts for approximately 80%95% of all cases of hypertension. However, the decision to do surgery is often guided by the age and general health of the patient. Understanding hypertension and the link to cardiovascular disease. Clinically known as hypertension, high blood pressure can cause a host of problems if left untreated. Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. This is called primary, or essential, hypertension. Common causes of secondary hypertension include renal parenchymal disease, renovascular hypertension, conn syndrome and pheochromocytoma.
Other causes of secondary hypertension hypertension has also been associated with hypercalcemia due to any cause. Lifestyle modifications introduction hypertension remains the leading cause of cardiovascular disease cvd, affecting approximately 1 billion individuals worldwide 1. Several drugs can induce or exacerbate preexisting hypertension, with nonsteroidal antiinflammatory drugs being the most common due to their wide use. In some people, their high blood pressure is the result of another medical problem or medication. In these cases, the condition is referred to as secondary hypertension. Review the the minority view on targeting systolic blood pressure goal of less than 150 mmhg in patients aged 60 years or older. About 10% of hypertension is secondary to some identifiable cause. In such cases, when the root cause is treated, blood pressure. The most common type of cardiovascular disease, high blood pressure causes our hearts to work harder by forcing blood to push against the walls of our arteries at an elevated level.
Clinical practice guidelines for the management of. High blood pressure typically does not cause symptoms. Treatment of systemic hypertension 162 am j cardiovasc dis 2012. Epidemiology of secondary hypertension in children. The treatment of secondary hypertension depends on its cause. Do not combine an acei with an arb to treat hypertension.
More than 72 million americans, or nearly 1 in 3 adults, are estimated to have hypertension but. Secondary hypertension is attributable to an underlying medical disorder. Common secondary causes of resistant hypertension and. Secondary hypertension an overview sciencedirect topics. Many of the risk factors that contribute to the development and progression of primary hypertension are closely related and cannot be easily separated. High blood pressure causes the heart to have to work harder to push. Fewer than 10% of patients have secondary hypertension.
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