SECONDARY HYPERTENSION-RENOVASCULAR HTN

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SUMMARY

1. Renovascular HTN (renal artery stenosis and fibromus­cular dysplasia) causing secondary hyperaldosteronism is the most common cause of secondary HTN.

2. Consider renovascular HTN in patients < 30 years of age (fibromuscular), onset of HTN in patients > 55 years of age (atherosclerotic), HTN + unexplained hypokalemia, accelerated HTN.

3. Combination of a continuous abdominal bruit and hypo­kalemia in a hypertensive patient is strongly suggestive of renovascular HTN.

4. Investigate with Doppler US, CT angiography. DSA is gold standard, but invasive.

5. Do not screen elderly patients with mild hypertension and a normal serum potassium.


Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].