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.
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.
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- ACEi :
Angiotensin-converting enzyme inhibitor
- ACTH :
- AME :
Apparent mineralocorticoid excess
- ARB :
Angiotensin receptor blocker
- ARR :
- 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 :
- FMD :
- GRA :
- MAO :
- MRA :
Mineralocorticoid receptor antagonist
- NSAIDs :
Nonsteroidal anti-inflammatory drugs
- OSA :
Obstructive sleep apnea
- PA :
- PAC :
Plasma aldosterone concentration
- PRA :
Plasma renin activity
- RAAS :
- PSV :
Peak systolic velocities
- RAR :
- RAS :
Renal artery stenosis
- VEGF :
Vascular endothelial growth factor
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Jamie S. Hirsch and Susana Hong each declare no potential \conflicts of interest.
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Hirsch, J.S., Hong, S. The Demystification of Secondary Hypertension: Diagnostic Strategies and Treatment Algorithms. Curr Treat Options Cardio Med 21, 90 (2019). https://doi.org/10.1007/s11936-019-0790-8
- Secondary hypertension
- Endocrine hypertension
- Drug-induced hypertension
- Renovascular hypertension
- Renal artery stenosis
- Obstructive sleep apnea
- Primary aldosteronism
- Cushing’s syndrome