CAUSES OF SECONDARY HYPERTENSION

SUMMARY

1. Think of primary hyperaldosteronism in a hypertensive patient with hypokalemia and low renin.

2. Think of pheochromocytoma in a hypertensive with recurrent and intermittent episodes of severe hypertension, frequently accompanied by palpitations and severe apprehension.

3. Systolic abdominal bruits (without a diastolic bruit) suggest renal vascular hypertension. Bilateral renal artery stenosis (RAS) can lead to severe exacerbation of hypertension and decline in renal function with initiation of ACE inhibitors or ARBs. Imaging to diagnose RAS include duplex ultrasonography, CTA (in individuals with normal renal function), and magnetic resonance angiography (MRA).

Reference(s)

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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].