Secondary Hypertension Flashcards
What is essential hypertension?
No clear etiology causing hypertension
What is secondary hypertension?
Underlying (potentially correctable) etiology
What are the statistics for occurrence of secondary hypertension?
1/3 of adults have hypertension and 5-10% of those adults have secondary HTN; children with hypertension almost all have secondary hypertension
What is one strong indication for the presence of secondary hypertension?
Resistant hypertension: elevated BP despite patients adherence to optimal dosage of 3 antihypertensive agents including a diuretic
What is arm to leg systolic BP difference over 20 mmHg or delayed or absent femoral pulses indicative of?
Aorta coarctation
What is increase in serum creatinine concentration after starting ACE inhibitors indicative of?
Renal artery stenosis
What indicates thyroid disorders?
Brady/tachycardia
Cold/heat intolerance
Constipation/diarrhea
What does hypokalemia indicate?
Aldosteronism
What are the obstructive sleep apnea symptoms?
Apneic events during sleep
Daytime sleepiness
Snoring
What are pheochromocytoma symptoms?
Headaches Orthostatic hypotension Palpitations Sweating Syncope Flushing
What are Cushing syndrome symptoms?
Buffalo hump
Central obesity
Moon face
Striae
Most common cause of secondary hypertension in children/adolescents?
Renal parenchymal disease
Coarctation of the aorta
Percentage of children with hypertension that have a secondary cause?
70-85%
Adolescents:
10-15%
Young adults:
5%
Middle-aged adults:
8-12%
Older adults:
17%
Most common cause of secondary hypertension in young adults?
Thyroid dysfunction
Fibromuscular dysplasia
Renal parenchymal disease
Most common cause in middle-aged adults?
Aldosteronism Thyroid dysfunction OSA Cushing syndrome Pheochromocytoma
Most common cause in older adults?
Atherosclerotic renal artery stenosis
Renal failure
Hypothyroidism
Statistics of coarctation of the aorta:
Coarctation is 2nd most common cause in children 2-5x more common in boys Presents as CHF in neonates Typical diagnosis around 5 years old Rarely presents in adults
What is fibromuscular dysplasia and what does it typically affect?
Narrowing of the artery typically the renal arteries decreasing renal perfusion
What is a sign of renal fibromuscular dysplasia?
High-pitched holosystolic renal artery bruit
Fibromuscular dysplasia is the most common cause of secondary HTN in which age group?
Young adults
What is primary aldosteronism?
Hyperaldosteronism
Most common cause of resistant HTN?
Aldosteronism
What should lead you to suspect renal artery stenosis?
Development of HTN after age 50
Known atherosclerosis elsewhere
Unexplained renal insufficiency
Rapid deterioration of the kidneys
