Secondary hypertension

Description

Side of the high blood pressure (secondary hypertension) is the high blood pressure that's caused by another medical condition. It can be caused by conditions that affect the kidneys, arteries, heart or endocrine system. Secondary hypertension can also occur during pregnancy.

Secondary hypertension differs from the usual type of high blood pressure (primary hypertension or essential hypertension), which is often simply referred to as high blood pressure.

The appropriate treatment of secondary hypertension can often control the high blood pressure and the condition of the cause. Effective treatment reduces the risk of serious complications, including heart disease, kidney failure, and stroke.

Symptoms

As primary hypertension, secondary hypertension usually has no specific symptoms, even if blood pressure has reached dangerously high levels.

For people with a diagnosis of high blood pressure, have any of these symptoms may mean that the condition is secondary hypertension:

  • The high blood pressure that does not respond to medications for blood pressure (resistant hypertension)
  • Very high blood pressure — systolic blood pressure of more than 180 millimeters of mercury (mm Hg) or diastolic blood pressure of more than 120 millimeters of mercury (mm Hg)
  • The high blood pressure that does not respond to the medication that controls blood pressure
  • Sudden onset of high blood pressure before age 30 or after 55 years of age
  • There is a family history of high blood pressure
  • Without obesity

When to see a doctor

If you have a condition that can cause secondary hypertension, you may need to get your blood pressure more often. Ask your health care provider how often to have your blood pressure checked.

Causes

Many health conditions can cause secondary hypertension. Several kidney diseases can cause secondary hypertension, including:

  • The complications of Diabetes (diabetic nephropathy). Diabetes can damage the kidneys, the filtration system, which can lead to high blood pressure.
  • Polycystic kidney disease. In this inherited condition, the cysts in the kidneys interfere with kidney function and can raise blood pressure.
  • Glomerular Disease. The kidneys eliminate the waste of sodium and the use of tiny filters called glomeruli. In glomerular disease, these filters are swell. This can raise the blood pressure.
  • Renovascular hypertension.This type of high blood pressure is caused by narrowing (stenosis) of one or both of the arteries that carry blood to the kidneys. Renovascular hypertension is often caused by the same type of fatty plaques that can cause damage to the coronary arteries (atherosclerosis) or a condition in which the muscle and fibrous tissues of the renal artery wall thicken and harden into rings (fibromuscular dysplasia).

Renovascular hypertension. This type of high blood pressure is caused by narrowing (stenosis) of one or both of the arteries that carry blood to the kidneys.

Renovascular hypertension is often caused by the same type of fatty plaques that can cause damage to the coronary arteries (atherosclerosis) or a condition in which the muscle and fibrous tissues of the renal artery wall thicken and harden into rings (fibromuscular dysplasia).

Medical conditions that affect hormone levels can also cause secondary hypertension. These conditions include:

  • Cushing's syndrome. In this condition, corticosteroids can cause secondary hypertension, or high blood pressure can be caused by a tumor of the pituitary gland, or other factors that cause the adrenal glands to produce too much of the hormone cortisol.
  • Aldosteronism. The adrenal glands produce too much of the hormone aldosterone. This causes the kidneys to retain salt and water and to lose the excess potassium, which increases the blood pressure.
  • The pheochromocytoma. This rare tumor, usually found in the adrenal gland produces too much of the hormones adrenaline and noradrenaline. Have this tumor can cause long-term high blood pressure or short-term spikes in blood pressure.
  • Problems of the thyroid. When the thyroid gland does not produce enough thyroid hormone (hypothyroidism), or produces too much thyroid hormone (hyperthyroidism), high blood pressure can result.
  • The hyperparathyroidism. The parathyroid glands control the calcium and phosphorus levels in the body. If the glands release too much parathyroid hormone, the amount of calcium in the blood rises — which triggers a rise in blood pressure.

Other possible causes of secondary hypertension include:

  • Coarctation of the aorta. In this condition, present at birth, the body's main artery (aorta) is reduced (coarctation). This forces the heart to pump harder to get blood through the aorta and the rest of the body. As a result, blood pressure increases, particularly in the arms.
  • Sleep apnea.In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing a lack of oxygen. Not getting enough oxygen can damage the lining of the walls of the blood vessels, which can make it harder for the blood vessels to control blood pressure. Also, sleep apnea causes part of the nervous system to be overactive and the release of certain chemicals that increase blood pressure.
  • Obesity.As body weight increases, the amount of blood that flows through the body increases. This increase in blood flow increases the pressure on the walls of the arteries, increased blood pressure. Being overweight also increases the heart rate and makes it more difficult for the blood vessels for the blood to circulate. In addition, the deposits of fat can release chemicals that increase blood pressure.
  • Pregnancy. Pregnancy can make the existing high blood pressure worse or cause high blood pressure to develop (pregnancy-induced hypertension or pre-eclampsia).
  • Medications and supplements.Several prescription medicines — such as pain relievers, birth control pills, antidepressants and drugs used after organ transplants — may cause or worsen high blood pressure in some people. Some decongestants and herbal supplements, including ginseng, licorice, and ephedra (ma huang), you can have the same effect. Many illegal drugs, such as cocaine and methamphetamine, also increases the blood pressure.

Sleep apnea. In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing a lack of oxygen.

Not getting enough oxygen can damage the lining of the walls of the blood vessels, which can make it harder for the blood vessels to control blood pressure. Also, sleep apnea causes part of the nervous system to be overactive and the release of certain chemicals that increase blood pressure.

Obesity. As body weight increases, the amount of blood that flows through the body increases. This increase in blood flow increases the pressure on the walls of the arteries, increased blood pressure.

Being overweight also increases the heart rate and makes it more difficult for the blood vessels for the blood to circulate. In addition, the deposits of fat can release chemicals that increase blood pressure.

Medications and supplements. Several prescription medicines — such as pain relievers, birth control pills, antidepressants and drugs used after organ transplants — may cause or worsen high blood pressure in some people.

Some decongestants and herbal supplements, including ginseng, licorice, and ephedra (ma huang), you can have the same effect. Many illegal drugs, such as cocaine and methamphetamine, also increases the blood pressure.

Risk factors

The greatest risk factor for developing secondary hypertension is to have a medical condition that can cause high blood pressure, such as the kidneys, arteries, heart or endocrine system problems.

Complications

Secondary hypertension can worsen underlying medical condition that is causing the high blood pressure. Without treatment, the secondary hypertension can lead to other health problems, such as:

  • The damage to the arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause the blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be deadly.
  • Heart failure. To pump blood against the higher pressure in the blood vessels, the heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body's needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in the kidneys. This may prevent the kidneys to function properly.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in the loss of vision.
  • The metabolic syndrome.This syndrome is a cluster of disorders of the metabolism of the body — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), high blood pressure and high insulin levels. If you have high blood pressure, you are more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or a stroke.
  • Problems with memory or understanding. Uncontrolled high blood pressure can also affect the ability to think, remember and learn. Problems with memory or understanding concepts is more common in people who have high blood pressure.

The metabolic syndrome. This syndrome is a cluster of disorders of the metabolism of the body — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), high blood pressure and high insulin levels.

If you have high blood pressure, you are more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or a stroke.

Secondary hypertension

Diagnosis

To diagnose secondary hypertension, a doctor will take a blood pressure reading using an inflatable cuff.

A care provider could not diagnose secondary hypertension based on a single high blood pressure reading. It may take 3 to 6 of the high blood pressure measurements in different appointments to diagnose secondary hypertension. Home blood pressure monitoring and ambulatory blood pressure monitoring could make some of these readings. With ambulatory blood pressure monitoring, a device for taking blood pressure measurements automatically at specific times throughout the day.

Other tests to help determine the cause of the high blood pressure may include:

  • Blood tests. Blood tests are often done to check the levels of potassium, sodium, creatinine, blood glucose, and total cholesterol and triglycerides, among others.
  • A urine test (urinalysis). A urine sample can contain markers that may point to medical conditions that can cause high blood pressure.
  • Ultrasound of the kidneys. Many kidney conditions are linked to the secondary hypertension. In this noninvasive test, a technician moves a small handheld device called a transducer over the area to be evaluated. The transducer sends sound waves into the body, picks up the bounce and is sent to a computer. The computer then creates images of the kidneys.
  • Electrocardiogram (ECG or EKG).This painless, non-invasive test records the electrical signals in the heart. This test can help determine if a heart problem could be the cause of secondary hypertension. In this test, the sensors (electrodes) are attached on the chest and sometimes to the limbs. The sensors are connected to a computer that records the heart's electrical signal information and shows like the waves on a monitor or on paper. This test shows how the heart is beating.

Electrocardiogram (ECG or EKG). This painless, non-invasive test records the electrical signals in the heart. This test can help determine if a heart problem could be the cause of secondary hypertension.

In this test, the sensors (electrodes) are attached on the chest and sometimes to the limbs. The sensors are connected to a computer that records the heart's electrical signal information and shows like the waves on a monitor or on paper. This test shows how the heart is beating.

Treatment

The treatment for secondary hypertension is the treatment of the medical condition that causes with medications or surgery. Once the condition is treated, the blood pressure may decrease or return to normal.

The treatment may need to continue taking medications for blood pressure, as well. The underlying medical condition may affect the choice of this medicine.

Possible drug options include:

  • The thiazide diuretics.Diuretics, sometimes called water pills, are medicines that help the kidneys to remove sodium and water. Thiazide diuretics are often the first but not the only choice in high blood pressure medications. Diuretics are often generic and tend to be less expensive than other high blood pressure medications. If you are not taking a diuretic, and your blood pressure remains high, talk with your provider about the addition of one or substitution of a medicine you are taking a diuretic. Possible side effects of diuretics include weakness, leg cramps, and an increased risk of having sexual problems.
  • Beta-blockers.These medications reduce the workload of the heart and open the blood vessels. This causes the heart to beat more slowly and with less force. When prescribed alone, beta-blockers do not work as well in Black, but they are effective when combined with a thiazide diuretic. Possible side effects include fatigue, sleep problems, decreased heart rate, and cold hands and feet. Beta-blockers are usually not used for people with asthma, as they can increase muscle spasms in the lungs.
  • Angiotensin-converting enzyme (ACE) inhibitors.These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. angiotensin-converting enzyme (ACE) inhibitors may be especially important in the treatment of high blood pressure in people with coronary artery disease, heart failure, or kidney failure. As the beta-blockers,ACEinhibitors not work as well in Black people when prescribed alone, but are effective when combined with a thiazide diuretic. Possible side effects include dizziness and cough.ACEinhibitors should not be taken during pregnancy.
  • Angiotensin II receptor blockers.These medications help relax blood vessels by blocking the action of a natural chemical that narrows blood vessels. LikeACEinhibitors, angiotensin II receptor blockers are often helpful for people with coronary artery disease, heart failure, or kidney failure. These drugs have less potential side effects of doACEinhibitors. Angiotensin II receptor blockers should not be used during pregnancy.
  • Calcium channel blockers.These drugs help relax the muscles of the blood vessels or decrease the heart rate. Calcium channel blockers may work better for some people thanACEinhibitors or beta-blockers alone. Possible side effects include water retention, dizziness, and constipation. Grapefruit juice interacts with some calcium channel blockers, increased levels of the medication in the blood and increase the risk of side effects. Ask your health care provider or pharmacist if it is the juice of grapefruit affects your medication.
  • Direct renin inhibitors.These medicines relax and widen the arteries by preventing the action of a protein (enzyme) called renin. An example of an inhibitor of the renin is as aliskiren (Tekturna). The common side effects of aliskiren, which include dizziness and diarrhea. People with diabetes, or moderate to severe kidney problems should not use aliskiren in combination withACEinhibitors inhibitors or angiotensin II.

The thiazide diuretics. Diuretics, sometimes called water pills, are medicines that help the kidneys to remove sodium and water. Thiazide diuretics are often the first but not the only choice in high blood pressure medications.

Diuretics are often generic and tend to be less expensive than other high blood pressure medications. If you are not taking a diuretic, and your blood pressure remains high, talk with your provider about the addition of one or substitution of a medicine you are taking a diuretic. Possible side effects of diuretics include weakness, leg cramps, and an increased risk of having sexual problems.

Beta-blockers. These medications reduce the workload of the heart and open the blood vessels. This causes the heart to beat more slowly and with less force. When prescribed alone, beta-blockers do not work as well in Black, but they are effective when combined with a thiazide diuretic.

Possible side effects include fatigue, sleep problems, decreased heart rate, and cold hands and feet. Beta-blockers are usually not used for people with asthma, as they can increase muscle spasms in the lungs.

Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. angiotensin-converting enzyme (ACE) inhibitors may be especially important in the treatment of high blood pressure in people with coronary artery disease, heart failure, or kidney failure.

As the beta-blockers, ACE inhibitors do not work as well in people of Black race when prescribed alone, but are effective when combined with a thiazide diuretic. Possible side effects include dizziness and cough. ACE inhibitors should not be taken during pregnancy.

Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action of a natural chemical that narrows blood vessels. As the ACE inhibitors, blockers of angiotensin II receptors often are helpful for people with coronary artery disease, heart failure, or kidney failure.

These drugs have less potential side effects than ACE inhibitors. Angiotensin II receptor blockers should not be used during pregnancy.

Calcium channel blockers. These drugs help relax the muscles of the blood vessels or decrease the heart rate. Calcium channel blockers may work better for some people than ACE inhibitors or beta-blockers alone. Possible side effects include water retention, dizziness, and constipation.

Grapefruit juice interacts with some calcium channel blockers, increased levels of the medication in the blood and increase the risk of side effects. Ask your health care provider or pharmacist if it is the juice of grapefruit affects your medication.

Direct renin inhibitors. These medicines relax and widen the arteries by preventing the action of a protein (enzyme) called renin. An example of an inhibitor of the renin is as aliskiren (Tekturna).

The common side effects of aliskiren, which include dizziness and diarrhea. People with diabetes, or moderate to severe kidney problems should not use aliskiren in combination with ACE inhibitors or blockers of angiotensin II receptors.

The treatment for secondary hypertension can sometimes be complicated. It could take more than one medicine combined with lifestyle changes to control high blood pressure. Your health care provider will want to see you more often — possibly as often as once a month until your blood pressure is controlled. Your doctor may also recommend that you keep a record of your blood pressure at home.

Self-care

Healthy lifestyle is recommended for maintaining a healthy heart and low blood pressure. These include:

  • Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy products. Get plenty of potassium, which is found in fruits and vegetables, such as potatoes, spinach, bananas, apricots, to help prevent and control high blood pressure. Eat less saturated fat and total fat.
  • The reduction of salt in the diet.A lower intake of sodium to 1,500 milligrams (mg) per day — is appropriate for people 51 years of age and older and for persons of any age who are Black or who have hypertension, diabetes or chronic kidney disease. Healthy people can have as a goal to 2,300 milligrams (mg) a day or less. Reduce the salt required to put the salt shaker and pay attention to the amount of salt in processed foods, such as canned soups or frozen dinners.
  • Maintain a healthy weight. If you are overweight, lose up to 10 pounds (4.5 kilograms) can lower your blood pressure.
  • The increase in physical activity. Regular physical activity can help reduce your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
  • Limit the consumption of alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and two drinks per day for men.
  • No smoking. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, talk with your health care provider to help you quit smoking.
  • Stress management. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting enough sleep can help, too.

The reduction of salt in the diet. A lower intake of sodium to 1,500 milligrams (mg) per day — is appropriate for people 51 years of age and older and for persons of any age who are Black or who have hypertension, diabetes or chronic kidney disease. Healthy people can have as a goal to 2,300 milligrams (mg) a day or less.

Reduce the salt required to put the salt shaker and pay attention to the amount of salt in processed foods, such as canned soups or frozen dinners.

Preparing for your appointment

High blood pressure can be discovered during a routine examination. At that time, your primary care provider may order more tests or refer you to a provider that specializes in the treatment of the suspicion that the cause of your high blood pressure. For example, if your provider considers that a kidney problem is the cause of your high blood pressure, it is likely that you will have to be referred to a doctor who specializes in the treatment of disorders of the kidneys (nephrologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet for a certain number of hours prior to your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you take, including over-dose.
  • Write questions to ask their provider.

For secondary hypertension, some basic questions to ask include:

  • What do you think is the cause of my high blood pressure?
  • What tests do I need? Do these tests require any special preparation?
  • Is my blood pressure high temporary or long-term?
  • I have other health conditions. How can I best manage these conditions?
  • No dietary or activity restrictions that must be followed?
  • How often should I go back to have my blood pressure checked?
  • I need to check my blood pressure at home? If so, how often?
  • What type of blood pressure machine is the best? I can help you to learn how to use it correctly?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask questions such as:

  • Has someone in your family has been diagnosed with high blood pressure?
  • If yes, do you know the reason for the high blood pressure? For example, does your family have diabetes or kidney problems?
  • Has had unusual symptoms?
  • The amount of salt in your diet?
  • Has your weight changed recently?
  • If you are ever pregnant, it was her high blood pressure during pregnancy?
Symptoms and treatment of Secondary hypertension