Secondary Causes of Hypertension

Although not that common, consider the following (with accompanying history and/or physical examination findings) in patients with hypertension:

• Renovascular hypertension (renal artery stenosis)-abdominal bruits, older patients
• Pheochromocytoma-episodic flushing, htn, headache, new onset htn in younger patient
• Cushing's disease-abdominal striae (not very specific in Baltimore), new onset hyperglycemia, classic electrolyte abnormality: hypokalemic metabolic alkalosis
• Primary Aldosteronism-new onset htn and hypokalemia
• Hyperparathyroidism-htn and hypercalcemia
• Aortic coarctation-younger patients (even young adulthood), unequal upper and lower extremity blood pressures
• Sleep apnea-typically obese patients (but not necessarily), excessive snoring, day time sleepiness (again, not specific)
• Thyroid disease (hypo or hyper)-signs and symptoms of thyroid disease

Although most of the time the patient will end up having essential hypertension, these entities should at the very least be considered.

Journal of Hypertension 2007