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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

Abstract

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.

Summary

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.

Keywords

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

Abbreviations

ACEi

Angiotensin-converting enzyme inhibitor

ACTH

Adrenocorticotropic hormone

AME

Apparent mineralocorticoid excess

ARB

Angiotensin receptor blocker

ARR

Aldosterone-to-renin ratio

AVS

Adrenal vein sampling

CAH

Congenital adrenal hyperplasia

CCB

Calcium channel blocker

CKD

Chronic kidney disease

CPAP

Continuous positive airway pressure

DST

Overnight dexamethasone suppression testing

ENaC

Epithelial sodium channels

FH

Familial hyperaldosteronism

FMD

Fibromuscular dysplasia

GRA

Glucocorticoid-remediable hypertension

MAO

Monoamine oxidase

MRA

Mineralocorticoid receptor antagonist

NSAIDs

Nonsteroidal anti-inflammatory drugs

OSA

Obstructive sleep apnea

PA

Primary aldosteronism

PAC

Plasma aldosterone concentration

PRA

Plasma renin activity

RAAS

Renin-angiotensin-aldosterone system

PSV

Peak systolic velocities

RAR

Renal-to-aortic ratio

RAS

Renal artery stenosis

VEGF

Vascular endothelial growth factor

Notes

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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