Summary
Primarily hypervolaemic, high output forms of hypertension, with features indicating or strongly suggesting fluid overload as the cause of elevated cardiac output, resulting from renal disease with reduced glomerular filtration rate causing sodium retention, renal tubular causes of sodium retention, greatly excessive sodium intake and low renin hypertension, can be treated by reduction of sodium intake and potentiation of its excretion by diuretic therapy, removal of the cause (e.g. aldosteronoma), and calcium antagonists.
Excessive vasoconstriction resulting from noradrenaline (norepinephrine) in neurogenic hypertension, phaeochromocytoma, orthostatic hypertension and a-adrenergic drug administration; angiotensin excess due to renal ischaemia brought about by aortic coarctation, renal arterial and arteriolar stenosis, intraluminal obstruction, external renal compression, renin-producing tumours, intrinsic kidney diseases and excessive renin substrate; and vascular structural disorders such as atherosclerosis, arteriolitides and fibrosis with or without calcification of major arteries may also induce hypertension.
Secondary hypertension of uncertain mechanism may occur in hyperparathyroidism, hyper-or hypothyroidism, or acromegaly. All are best treated by appropriate correction of the endocrine excess or deficiency. It may also occur in pregnancy, where the mechanism may involve prostaglandin-thromboxane imbalance or calcium deficiency; calcium deficiency with some evidence of benefit from calcium supplements; and the recumbent hypertension paradoxically associated with autonomic failure. Excellent responses to specific correction of the underlying cause or pathogenetic mechanism is usual in young individuals but less frequent in older patients.
Similar content being viewed by others
References
Adlin EV, Marks AD, Channick BJ. Spironolactone and hydrochlorothiazide in essential hypertension. Archives of Internal Medicine 130: 855–858, 1972
Ames RP, Borkowski HJ, Sicinski AM, Laragh JH. Prolonged infusions of angiotensin II and norepinephrine and blood pressure, electrolyte balance and aldosterone and cortisol secretion in normal man and in cirrhosis with ascites. Journal of Clinical Investigation 44: 1171–1186, 1965
Atkinson AB, Brown JJ, Cumming AMM, Fraser R, Lever AF, et al. Captopril in the management of hypertension with renal artery stenosis. American Journal of Cardiology 49: 1460–1466, 1982
Aurell M, Rudin A, Tisell LE, Kindblom LG, Sandberg G. Captopril effect on hypertension in patient with renin-producing tumour. Lancet 2: 149–150, 1979
Belizan JM, Villar J. The relationship between calcium intake and edema, proteinuria and hypertension-gestosis: an hypothesis. American Journal of Clinical Nutrition 33: 2202–2210, 1980
Belizan JM, Villar J, Gonzalez L, Campodonico L, Bergel E. Calcium supplementation to prevent hypertensive disorders of pregnancy. New England Journal of Medicine 325: 1399–1405, 1991
Biglieri EG. Spectrum of mineralocorticoid hypertension. Hypertension 17: 251–261, 1991
Biglieri EG, Herron MA, Brust N. 17-hydroxylation deficiency in man. Journal of Clinical Investigation 45: 1946–1954, 1966
Blumberg A, Nelp WB, Hegstrom RM, Scribner BH. Extracellular volume in patients with chronic renal disease treated for hypertension by sodium restriction. Lancet 2: 69–73, 1967
Bonnin JM, Hodge RL, Lumbers ER. A renin-secreting renal tumour associated with hypertension. Australian and New Zealand Journal of Medicine 2: 178–181, 1972
Bravo EL, Tarazi RC, Gifford RW, Stewart BH. Circulating and urinary catecholamines in pheochromocytoma. New England Journal of Medicine 301: 682–686, 1979
Brickman AS, Stern N. Hypertension in pseudohypoparathyroidism type I. American Journal of Medicine 85: 785–792, 1988
Brinton GS, Jubiz W, Lagerquist LD. Hypertension in primary hyperparathyroidism: The role of the renin-angiotensin system. Journal of Clinical Endocrinology and Metabolism 41: 1025–1029, 1975
Brown JJ, Davies DL, Ferriss JB, Fraser R, Haywood E, et al. Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin. British Medical Journal 2: 729–734, 1972
Brown JJ, Lever AF, Robertson JIS, Fraser R, Marton JJ, et al. Hypertension and secondary hyperaldosteronism associated with a renin-secreting juxtaglomerular tumour. Lancet 2: 1228–1232, 1973
Brunner HR, Gavras H, Laragh JH. Angiotensin-II blockade in man by sar1-ala8-angiotensin-II for understanding and treatment of high blood pressure. Lancet 2: 1045–1048, 1973
Cappuccio FP, Markandu ND, Sagnella GA, Singer DRJ, Miller MA, et al. Acute and sustained changes in sodium balance during nifedipine treatment in essential hypertension. American Journal of Medicine 91: 233–238, 1991
Carey RM, Douglas JG, Schweikert JR, Liddle GW. The syndrome of essential hypertension and suppressed plasma renin activity. Archives of Internal Medicine 130: 849–854, 1972
Case DB, Atlas SA, Marion RM, Laragh JH. Long-term efficacy of captopril in renovascular and essential hypertension. American Journal of Cardiology 49: 1440–1446, 1982
Case DB, Wallace JM, Keim HJ, Weber MA, Drayer JIM, et al. Estimating renin participation in hypertension: superiority of converting enzyme inhibitor over saralasin. American Journal of Medicine 61: 790–796, 1976
Christensen NJ. Plasma noradrenaline and adrenaline in patients with thyrotoxicosis and myxoedema. Clinical Science and Molecular Medicine 45: 163–171, 1973
Conn SW, Cohen EL, Lucas CP, McDonald WJ, Mayor GH et al. Primary reninism. Archives of Internal Medicine 130: 682–696, 1972
Corea L, Bentivoglio M, Verdecchia P, Providenza M. Converting enzyme inhibition vs diuretic therapy as first therapeutic approach to the elderly hypertensive patient. Current Therapeutic Research 36: 347–351, 1984
Crandon AJ, Isherwood DM. Effect of aspirin on incidence of pre-eclampsia. Lancet 1: 1356, 1979
Cuocolo A, Esposito S, Volpe M, Celentano L, Brunetti et al. Renal artery stenosis detection by combined Gates’ technique and captopril test in hypertensive patients. Journal of Nuclear Medicine 30: 51–56, 1989
Curtis JJ, Luke RG, Jones P, Diethelm AG, Whetchel JD. Hypertension after renal transplantation. American Journal of Medicine 79: 193–200, 1985
Dahlberg PJ, Frecentese DF, Cogbill TH. Cholesterol embolism: experience with 22 historically proven cases. Surgery 105: 737–746, 1989
Dalakos TG, Elias AN, Anderson Jr GH, Streeten DHP, Schroeder ET. Evidence for an angiotensinogenic mechanism of the hypertension in Cushing’s syndrome. Journal of Clinical Endocrinology and Metabolism 46: 114–118, 1978
Dalakos TG, Streeten DHP, Jones D, Obeid A. ‘Malignant’ hypertension resulting from atheromatous embolization predominantly of one kidney. American Journal of Medicine 57: 135–138, 1974
Dang CV, Schlott DW, Watson AJS, Gimenez L, Klassen DK. Horseshoe kidney and renovascular hypertension responsive to percutaneous transluminal angioplasty. Annals of Internal Medicine 102: 70–71, 1985
DeLellis RA, Wolfe HJ, Gagel RF, et al. Adrenal medullary hyperplasia: a morphometric analysis in patients with familial medullary thyroid carcinoma. American Journal of Pathology 83: 177–196, 1976
De Champlain J, Farley L, Cousineau D, van Ameringen M-R. Circulating catecholamine levels in human and experimental hypertension. Circulation Research 38: 109–114, 1976
DeQuattro V, Lee DD-P, Allen J, Sirgo M, Plachetka J. Labetalol blunts morning pressure surge in systolic hypertension. Hypertension 11 (Suppl. 1): 198–201, 1988
DeQuattro V, Chan S. Raised plasma catecholamines in some patients with primary hypertension. Lancet 1: 806–809, 1972
Dickinson CJ. Neurogenic hypertension revisited. Clinical Science 60: 471–477, 1981
Dluhy RG, Smith K, Taylor T, Hollenberg NK, Williams GH. Prolonged converting enzyme inhibition in non-modulating hypertension. Hypertension 13: 371–377, 1989
Douglas JG, Hollifield JW, Liddle GW. Treatment of low renin essential hypertension: Comparison of spironolactone and a hydrochlorothiazide-triamterene combination. Journal of the American Medical Association 227: 518–521, 1974
Eddy RL, Sanchez SA. Renin-secreting renal neoplasm and hypertension with hypokalemia. Annals of Internal Medicine 75: 725–729, 1971
Elias AN, Anderson Jr GH, Dalakos TG, Streeten DHP. Renin angiotensin involvement in transient hypertension after renal injury. Journal of Urology 119: 561–562, 1978
Engelman K, Portnoy B, Sjoerdsma A. Plasma catecholamine concentrations in patients with hypertension. Circulation Research 26 and 27 (Suppl. 1): 141–146, 1970
Erne P, Bolli P, Bertel O, Hulthen UL, Kiowski W, et al. Factors influencing the hypotensive effects of calcium antagonists. Hypertension 5 (Suppl. 2): II-97–II-102, 1983
Esler M, Jennings G, Lambert G. Noradrenaline release and the pathophysiology of primary human hypertension. American Journal of Hypertension 2: 140S–146S, 1989
Esler M, Ferrier C, Lambert G, Eisenhofer G, Cox H, et al. Biochemical evidence of sympathetic hyperactivity in human hypertension. Hypertension 17 (Suppl. 3): III-29–III-35, 1991
Fontes RG, Kater CE, Biglieri EG, Irony I. Reassessment of the predictive value of the postural stimulation test in primary aldosteronism. American Journal of Hypertension 4: 786–791, 1991
Friedman SA. Preeclampsia: a review of the role of prostaglandins. Obstetrics and Gynecology 71: 122–137, 1988
Fujita T, Henry WL, Bartter FC, Lake CR, Delea CS. Factors influencing blood pressure in salt-sensitive patients with hypertension. American Journal of Medicine 69: 334–344, 1980
Ganguly A, Weinberger WH. Triamterene-thiazide combination: alternative therapy for primary aldosteronism. Clinical Pharmacology and Therapeutics 30: 246–250, 1981
Ganguly A, Weinberger MH, Passmore JM, Caras JA, Khairi RM, et al. The renin-angiotensin-aldosterone system and hypertension in primary hyperparathyroidism. Metabolism 31: 595–600, 1982
Gant NF, Daley GL, Chand S, Whalley PJ, MacDonald PC. A study of angiotensin II pressor response throughout primigravid pregnancy. Journal of Clinical Investigation 52: 2682–2689, 1973
Genest J, Rojo-Ortega JM, Kuchel O, et al. Malignant hypertension with hypokalemia in a patient with renin-producing pulmonary carcinoma. Transactions of Association of American Physicians 88: 192–201, 1975
Geyskes GG, Oei HY, Puylaert CBAJ, Mees EJD. Renovascular hypertension identified by captopril-induced changes in the renogram. Hypertension 9: 451–458, 1987
Golden JG, Stone RA, Goldenberger LE, Coel MN. Renovascular hypertension and horseshoe kidney. Journal of the American Medical Association 235: 2419–2420, 1976
Griffing GT, Cole AG, Aurecchia SA, Sindler BH, Komanicky P, et al. Amiloride in primary hyperaldosteronism. Clinical Pharmacology and Therapeutics 31: 56–61, 1982
Grim CE, Mullins MF, Nilson JP, Ross Jr G. Unilateral ‘Page kidney’ hypertension in man. Studies of the renin-angiotensin-aldosterone system. Journal of the American Medical Association 231: 42–45, 1975
Haas DC, Anderson Jr GH, Streeten DHP. Role of angiotensin in lethal cerebral hypoperfusion during treatment of acute hypertension. Archives of Internal Medicine 145: 1922–1924, 1985
Haas DC, Streeten DHP, Kim RC, Naalbandian AN, Obeid AI. Death from cerebral hypoperfusion during treatment of acute angiotensin-dependent hypertension. American Journal of Medicine 75: 1071–1076, 1983
Hellström J, Birke G, Edvall CA. Hypertension in hyperparathyroidism. British Journal of Urology 30: 13–24, 1958
Imperiale TF, Petrulis AS. A meta-analysis of low-dose aspirin for the prevention of pregnancy-induced hypertensive disease. Journal of the American Medical Association 266: 260–264, 1991
Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu’s arteriopathy. Journal of the American College of Cardiology 12: 964–972, 1988
Kaplan NM, Meese RB. The calcium deficiency hypothesis of hypertension: a critique. Annals of Internal Medicine 105: 947–955, 1986
Kawasaki T, Delea CS, Bartter FC, Smith H. The effect of high sodium and low-sodium intakes on blood pressure and other related variables in human subjects with idiopathic hypertension. American Journal of Medicine 64: 193–198, 1978
Kern DC, Weinberger MH, Mayes DM, et al. Saline suppression of plasma aldosterone in hypertension. Archives of Internal Medicine 128: 380–386, 1971
Kincaid-Smith P. Malignant hypertension. Journal of Hypertension 9: 893–899, 1991
Kincaid-Smith P, McMichael J, Murphy EA. The clinical course and pathology of hypertension with papilloedema (malignant hypertension). Quarterly Journal of Medicine 27: 117–153, 1958
Krakoff LE, Nicolis G, Amsel B. Pathogenesis of hypertension in Cushing’s syndrome American Journal of Medicine 58: 216–220, 1975
Kremer D, Boddy K, Brown JJ, Davies DL, Fraser R, et al. Amiloride in the treatment of primary hyperaldosteronism and essential hypertension. Clinical Endocrinology 7: 151–157, 1977
Laragh JH, Baer L, Brunner HR, Bühler FR, Sealey JE, et al. Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease. American Journal of Medicine 52: 633–652, 1972
Laragh JH, Sealey JE, Bühler FR, Vaughan ED, Brunner HR, et al. The renin axis and vasoconstriction volume analysis for understanding and treating renovascular and renal hypertension. American Journal of Medicine 58: 4–13, 1975
Laragh JH, Sealey JE, Ledingham JGG, Newton MA. Oral contraceptives. Renin, aldosterone and high blood pressure. Journal of the American Medical Association 201: 918–922, 1967
Louis WS, Doyle AE, Anavekar S. Plasma norepinephrine levels in essential hypertension. New England Journal of Medicine 288: 599–601, 1973
Luft FC, Rankin LI, Bloch R, Weyman AE, Willis LR, et al. Cardiovascular and humoral responses to extremes of sodium intake in normal black and white men. Circulation 60: 697–706, 1979
MacGregor GA, Markandu ND, Best FE, Elder DM, Cam JM, et al. Double-blind randomized crossover trial of moderate sodium restriction in essential hypertension. Lancet 1: 351–355, 1982
Mann S, Altman DG, Raftery EB, Bannister R. Circadian variation of blood pressure in autonomic failure. Circulation 68: 477–483, 1983
Maxwell MH, Marks LS, Varady PD, Lupu AN, Kaufman JJ. Renal vein renin in essential hypertension. Journal of Laboratory and Clinical Medicine 86: 901–909, 1975
McCarron DA. Calcium metabolism and hypertension. Kidney International 35: 717–736, 1989
McCarron DA, Morris CD. Blood pressure response to oral calcium in persons with mild to moderate hypertension. Annals of Internal Medicine 103: 825–831, 1985
McCarron DA, Morris CD, Cole C. Dietary calcium in human hypertension. Science 217: 267–269, 1982
Melby JC. Clinical Review 1: endocrine hypertension. Journal of Clinical Endocrinology and Metabolism 69: 697–703, 1989
Montalbano FP, Baronofsky ID, Ball H. Hyperplasia of the adrenal medulla. A clinical entity. Journal of the American Medical Association 182: 264–267, 1962
Muirhead EE, Brooks B, Byers LW, Brown P, Pitcock JA. Medullipin system. Generation of medullipin II by isolated kidney-liver perfusion. Hypertension 19 (Suppl. 3): III-158–III-163, 1991
Nadler JL, Hsueh W, Horton R. Therapeutic effect of calcium channel blockade in primary aldosteronism. Journal of Clinical Endocrinology and Metabolism 60: 896–899, 1985
O’Malley K, Cox JP, O’Brien E. Choice of drug treatment for elderly hypertensive patients. American Journal of Medicine 90 (Suppl. 3A): 27S–33S, 1991
Oster JR, Materson BJ. The dilemma of pseudohypertension. Geriatric Cardiovascular Medicine 1: 23–27, 1988
Page IH. The production of persistent arterial hypertension by cellophane perinephritis. Journal of the American Medical Association 113: 2046–2048, 1939
Pang PKT, Benishin CG, Lewanczuk RZ. Parathyroid hypertensive factor, a circulating factor in animal and human hypertension. American Journal of Hypertension 4: 472–477, 1991
Parker FB, Anderson Jr GH, Streeten DHP. Secondary hypertension. Hypertension secondary to coarctation. In Amery A (Ed.) Hypertensive cardiovascular disease: pathophysiology and treatment, pp. 492–507, Martinus Nijhoff, The Hague, 1982a
Parker FB, Streeten DHP, Farrell B, Blackman MS, Sondheimer HM, et al. Preoperative and postoperative renin levels in coarctation of the aorta. Circulation 66: 513–514, 1982b
Pedersen EB, Christensen NJ, Christensen P, et al. Preeclampsia — a state of prostaglandin deficiency: urinary prostaglandin excretion, the renin-aldosterone system and circulating cate-cholamines in preeclampsia. Hypertension 5: 105–111, 1983
Pillari G, Fulco JD, Lee WJ. Hypernephroma and hypertension. Observations. New York State Journal of Medicine 79: 865–867, 1979
Resnick LM, Nicholson JP, Laragh JH. Calcium, the renin-aldosterone system and the hypotensive response to nifedipine. Hypertension 10: 254–258, 1987
Robertson D, Goldberg MR, Hollister AS, et al. Clonidine raises blood pressure in severe idiopathic orthostatic hypotension. American Journal of Medicine 74: 193–200, 1983
Robertson PW, Klidjian A, Harding LK, Walters G, Robb-Smith AHT. Hypertension due to a renin-secreting renal tumor. American Journal of Medicine 43: 963–976, 1967
Ruddy MC, Atlas SA, Salerno FG. Hypertension associated with a renin-secreting adenocarcinoma of the pancreas. New England Journal of Medicine 307: 993–997, 1982
Rydstedt LL, Williams GH, Hollenberg NK. Renal and endocrine response to saline infusion in essential hypertension. Hypertension 8: 217–222, 1986
Scott PL, Yune HY, Weinberger MH. Page kidney: an unusual cause of hypertension. Diagnostic Radiology 119: 547–548, 1976
Scribner BH, Fergus EB, Boen ST, et al. Some therapeutic approaches to chronic renal insufficiency. Annual Review of Medicine 16: 285–300, 1965
Shoback DM, Williams GH, Moore TJ, Dluhy RG, Podolsky S, et al. Defect in the sodium-modulated tissue responsiveness to angiotensin II in essential hypertension. Journal of Clinical Investigation 72: 2115–2124, 1983
Spergel G, Lustik B, Levy LJ, Ertel NH. Studies of hypertension and carbohydrate intolerance associated with Wilms tumor. Annals of Internal Medicine 70: 565–570, 1969
Streeten DHP. Orthostatic disorders of the circulation. Plenum, New York, 1987
Streeten DHP, Anderson Jr GH. Outpatient experience with saralasin. Kidney International 15: S44–S52, 1979
Streeten DHP, Anderson Jr GH, Freiberg JM, Dalakos TG. Use of angiotensin II antagonist (saralasin) in the recognition of ‘angiotensinogenic’ hypertension. New England Journal of Medicine 292: 657–662,. 1972
Streeten DHP, Anderson Jr JH. Angiotensin receptor blocking drugs, in Handbook of Hypertension, (Editors WH Birkenhager, JL Reid), Vol 5, Clinical Pharmacology of Antihypertensive Drugs (Editor AE Doyle), 2nd ed., pp. 274–300; Elsevier, Amsterdam 1988
Streeten DHP, Anderson Jr GH. Hypertension: relating drug therapy to pathogenetic mechanisms. Progress in Drug Research 32: 176–194, 1988
Streeten DHP, Anderson Jr GH, Howland J, Chiang R, Smulyan H. Effects of thyroid function on blood pressure. Recognition of hypothyroid hypertension. Hypertension 11: 78–83, 1988
Streeten DHP, Anderson Jr GH, Lebowitz M, Speller PJ. Primary hyperepinephrinemia in patients without pheochromocytoma. Archives of Internal Medicine 150: 1528–1533, 1990a
Streeten DHP, Anderson Jr GH, Wagner S. Effect of age on response of secondary hypertension to specific treatment. American Journal of Hypertension 3: 360–365, 1990b
Streeten DHP, Auchincloss Jr JH, Anderson Jr GH, Richardson RL, Thomas FD. Orthostatic hypertension: pathogenetic studies. Hypertension 7: 196–203, 1985
Streeten DHP, Tomycz N, Anderson Jr GH. Reliability of screening methods for the diagnosis of primary aldosteronism. American Journal of Medicine 67: 403–418, 1979
Sutherland DJA, Ruse JKL, Laidlaw JC. Hypertension, increased aldosterone secretion, and low plasma renin activity relieved by dexamethasone. Canadian Medical Association Journal 95: 1109–1119, 1966
Tarazi RC. Hemodynamic role of extracellular fluid in hypertension. Circulation Research 38 (Suppl. 2): II-73–II-83, 1976
Thorn GW, Koepf GF, Clinton Jr M. Renal failure simulating adrenocortical insufficiency. New England Journal of Medicine 231: 76–85, 1944
Vardan S, Mookherjee S, Warner R, Smulyan H. Systolic hypertension in the elderly: hemodynamic response to long-term diuretic therapy and its side effects. Journal of the American Medical Association 250: 2807–2813, 1983
Vertes V, Cangiano JL, Berman LB, Gould A. Hypertension in end-stage renal disease. New England Journal of Medicine 280: 978–981, 1969
Volhard F, Fahr T. Die Bightsche Nierenkrankheit. Springer Seminars in Immunopathology, 1914
Watt GCM, Edwards C, Hart JT, Hart M, Walton P, et al. Dietary sodium restriction for mild hypertension in general practice. British Medical Journal 286: 432–436, 1983
Weidmann P, Beretta-Piccoli C, Hirsch D, Reubi FC, Massry SG. Curable hypertension with unilateral hydronephrosis. Studies on the role of circulating renin. Annals of Internal Medicine 87: 437–440, 1977a
Weidmann P, Hirsch D, Beretta-Piccoli C, et al. Interrelations among blood pressure, blood volume, plasma renin activity and urinary catecholamines in benign essential hypertension. American Journal of Medicine 62: 209–218, 1977b
Weidmann P, Maxwell MH, Lupu AN, Lewin AJ, Massry SG. Plasma renin activity and blood pressure in terminal renal failure. New England Journal of Medicine 285: 757–762, 1971
Woods JW. Oral contraceptives and hypertension. Lancet 2: 653–654, 1967
Yokokawa K, Tahara H, Kohno M, Murakawa K, Yasunari K, et al. Hypertension associated with endothelin-secreting malignant hemangioendothelioma. Annals of Internal Medicine 114: 213–215, 1991
Youngberg SP, Sheps SG, Strong CG. Fibromuscular disease of the renal arteries. Medical Clinics of North America 61: 623–641, 1977
Yu S-H, Whitworth JA, Kincaid-Smith P. Malignant hypertension: aetiology and outcome in 83 patients. Clinical and Experimental Hypertension 8: 1211–1230, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Streeten, D.H.P., Anderson, G.H. Secondary Hypertension. Drugs 43, 805–819 (1992). https://doi.org/10.2165/00003495-199243060-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199243060-00002