When to Suspect Secondary Hypertension
A thorough history and physical examination together with selected, office-based laboratory studies are recommended in the evaluation of each new patient with hypertension (Table 13-1). This initial evaluation is designed to assess the presence or absence of target organ damage and cardiovascular disease, to identify other cardiovascular risk factors or comorbid conditions that may have an impact on the prognosis and selection of therapy, and to provide valuable clues to other secondary causes of hypertension. When preliminary examination affords no clues, an extensive search for secondary and possibly curable causes of hypertension is unproductive, unnecessarily costly, and, on occasion, may be hazardous. This chapter does not address the problem of alcohol excess, which represents the most common cause of reversible hypertension in our society, or oral contraceptive therapy, which may be associated with significant hypertension in a small number of women. Table 13-2 summarizes the information to be gained from the initial clinical evaluation regarding selected secondary causes of hypertension, and this information is discussed further in this chapter.
KeywordsMultiple Endocrine Neoplasia Primary Aldosteronism Resistant Hypertension Renovascular Hypertension Mandelic Acid
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- 1.Serfas D, Borow KM (1983) Coarctation of the aorta: anatomy, pathophysiology, and natural history. J Cardiovasc Med 8: 575.Google Scholar
- 4.Bravo EL (1991) Pheochromocytoma: new concepts and future trends. Kidney Int 40: 544–556 (clinical conference).Google Scholar
- 7.National High Blood Pressure Education Program (NHBPEP) Working Group (1996) 1995 Update of the working group reports on chronic renal failure and renovascular hypertension. Arch Intern Med 156: 1938–1947.Google Scholar
- 8.Moore MA (1993) Renal parenchymal disease: evaluation. In: Izzo JL, Black HR, eds. Hypertension Primer, 3rd ed., Dallas: American Heart Association, pp. 265–267.Google Scholar
- 9.Streeten DH, Anderson GH Jr, Howland T, Chiang R, Smulyan H (1988) Effects of thyroid function on blood pressure: recognition of hypothyroid hypertension. Hypertension 11:78–83.Google Scholar
- 10.Richards AM, Espiner EA, Nicholls MG, Ikram H, Hamilton EJ, Maslowski TA (1988) Hormone, calcium and blood pressure relationships in primary hyperparathyroidism. J Hypertens 6:747–752. (published erratum appears in J Hypertens 1988; 6 (11):ii).Google Scholar
- 11.Joint National Committee (1997) The sixth report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-VI). Arch Intern Med 157: 2413–2446.Google Scholar