Identifying secondary causes of hypertension

Question 1

Medications (and even herbal compounds) that can increase blood pressure:

NEED - A - MA

Answer 1

1. NSAIDs
2. Estrogen predominant oral contraceptives
3. Ephedra
4. Decongestants
5. Antidepressants
6. Ma huang
7. Alcohol

Question 2

Screen patients with resistant hypertension for secondary causes in the following circumstances:

Answer 2

1. HPT had an abrupt onset
2. Onset was < 30 yrs
3. > 65 develops only diastolic HPT
4. Unprovoked or excessive hypoK

Question 3

Commonest causes of secondary HPT:

Answer 3

1. Sleep apnea: 25–30%
2. ** Primary hyperaldosteronism:** 10–20%
3. RAS: 5–35%
4. Renal parenchymal disease: 1–2%
5. Thyroid disease: < 1%
6. Pheochromocytoma: 0.1%

Question 4

Screening for secondary causes - Sleep Apnea:

Answer 4

1. Epworth sleepiness score
2. Polysomnography

Question 5

Screening for secondary causes - Primary hyperaldosteronism:

Answer 5

1. Normal to low K
2. High aldosterone (> 15 ng / dL)
3. Aldosterone / renin ratio is > 20
4. Confirmatory Test - saline suppression test

Question 6

Screening for secondary causes - Renal artery stenosis:

Answer 6

1. Renal ultrasound
2. CT angiography
3. Magnetic resonance angiography

Question 7

Screening for secondary causes - Thyroid disease:

Answer 7

1. TFT - TSH & free T4
2. Cushing’s disease
3. Overnight dexamethasone suppression

Question 8

Screening for secondary causes -Pheochromocytoma:

Answer 8

1. Plasma metanephrines