The Demystification of Secondary Hypertension: Diagnostic Strategies and Treatment Algorithms

  • Jamie S. HirschEmail author
  • Susana Hong
Vascular Disease (M Weinberg, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Vascular Disease


Purpose of review

Hypertension is one of the most common conditions encountered in the primary care setting, affecting 32–46% of people. While essential or primary hypertension is the most common form of the disease, secondary hypertension is quite prevalent, occurring in 10–20% of patients with hypertension. Accurately diagnosing secondary hypertension is a challenging and often time-consuming process that requires considerable expertise and effort. However, once the secondary etiology is identified, the patient benefits profoundly from a potentially curative treatment that may lead to significant improvements in quality of life, morbidity, and mortality.

Recent findings

Common causes of secondary hypertension include medication-induced hypertension, renal parenchymal disease, renovascular hypertension, obstructive sleep apnea, and primary aldosteronism. Other rarer forms include mineralocorticoid-driven hypertension or its mimics, as well as hypercortisolism and pheochromocytoma. Although complex, standard protocols have emerged for investigation, diagnosis, and treatment of these conditions.


The current review aims to elucidate the many causes of secondary hypertension and describe their respective prevalence, clinical presentation, screening, diagnosis, treatment, and follow-up. By demystifying secondary hypertension, it is hoped that this disease will be more easily identified and treated so that the associated cardiovascular morbidity and end-organ damage may be mitigated.


Secondary hypertension Endocrine hypertension Drug-induced hypertension Renovascular hypertension Renal artery stenosis Obstructive sleep apnea Primary aldosteronism Mineralocorticoid Cushing’s syndrome Pheochromocytoma 



Angiotensin-converting enzyme inhibitor


Adrenocorticotropic hormone


Apparent mineralocorticoid excess


Angiotensin receptor blocker


Aldosterone-to-renin ratio


Adrenal vein sampling


Congenital adrenal hyperplasia


Calcium channel blocker


Chronic kidney disease


Continuous positive airway pressure


Overnight dexamethasone suppression testing


Epithelial sodium channels


Familial hyperaldosteronism


Fibromuscular dysplasia


Glucocorticoid-remediable hypertension


Monoamine oxidase


Mineralocorticoid receptor antagonist


Nonsteroidal anti-inflammatory drugs


Obstructive sleep apnea


Primary aldosteronism


Plasma aldosterone concentration


Plasma renin activity


Renin-angiotensin-aldosterone system


Peak systolic velocities


Renal-to-aortic ratio


Renal artery stenosis


Vascular endothelial growth factor


Compliance with Ethical Standards

Conflict of Interest

Jamie S. Hirsch and Susana Hong each declare no potential \conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Kidney Diseases and Hypertension, Department of MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellGreat NeckUSA
  2. 2.Institute of Health Innovations and Outcomes ResearchFeinstein Institutes for Medical Research, Northwell HealthNew YorkUSA
  3. 3.Department of Information ServicesNorthwell HealthNew YorkUSA

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