Secondary causes of hypertension

Question 1

In determining the cause of hypertension, what factor would give you a high suspicion for secondary hypertension?

Answer 1

AGE

-younger people wouldn’t typically have primary hypertension

Question 2

What are some causes of secondary hypertension?

Answer 2

1. Endocrine: tumors, Cushing’s
2. Renal artery stenosis
3. Drugs

Question 3

What causes high blood pressure in renal artery stenosis? What kind of tests would you do?

Answer 3

Decreased blood > increased renin > increased Ang II >> causes vasoconstriction + aldosterone

Test:

1. measure plasma renin activity
2. ultrasound w/ doppler
3. CTA
4. Renal angiogram

Question 4

Is treatment of the high BP with ACEI or ARBs sufficient with renal artery stenosis? How would you treat it?

Answer 4

Not sufficient!

-eventually could lead to ischemia or kidney damage

-Need surgical procedure!

• angioplasty or bipass (longer-lasting)

Question 5

If a patient comes in with new onset hypertension and decrease in K, what would come to your mind?

Answer 5

-Renin-Angiotensin-Aldo system defect

Question 6

If you do a workup to check the kidney, and find the follwing scenarios, what would be the caues of each case?

1. Renin= high, aldosterone= high
2. Renin= lower, aldosterone= high

Answer 6

1. Renin-mediated hypertension through aldo
2. Primary aldosteronism
   
   • Aldo-producing ademoma (unilateral)
   • Idiopathic adrenal hyperplasia (more common- bilateral)

Question 7

What would you do to prove your hypothesis that there is a primary aldosteronism?

Answer 7

Give saline or fludrocortisone!

• Normally aldo would drop in response
• If it doesn’t then something else is secreting it

Question 8

How would you distinguish between APA (adrenal-producing adenoma) and IAH (idiopathic adrenal hyperplasia)?

Answer 8

1. Stick a catheter in both adrenal veins
2. Measure aldo. coming out
3. If it’s unilateral >> APA
4. If it’s bilateral >> IAH

Question 9

Would someone with aldosteronism be alkalotic or acidotic? Hyperkalemic or hypokalemic?

Answer 9

Alkalotic- increased bicarb

-reabsorbing a lot of Na makes lumen more negative and can bind H+ and leave bicarb behind

Hypokalemic

-reabsorb Na which transfers K into lumen