Secondary Hypertension

Question 1

What is essential hypertension?

Answer 1

No clear etiology causing hypertension

Question 2

What is secondary hypertension?

Answer 2

Underlying (potentially correctable) etiology

Question 3

What are the statistics for occurrence of secondary hypertension?

Answer 3

1/3 of adults have hypertension and 5-10% of those adults have secondary HTN; children with hypertension almost all have secondary hypertension

Question 4

What is one strong indication for the presence of secondary hypertension?

Answer 4

Resistant hypertension: elevated BP despite patients adherence to optimal dosage of 3 antihypertensive agents including a diuretic

Question 5

What is arm to leg systolic BP difference over 20 mmHg or delayed or absent femoral pulses indicative of?

Answer 5

Aorta coarctation

Question 6

What is increase in serum creatinine concentration after starting ACE inhibitors indicative of?

Answer 6

Renal artery stenosis

Question 7

What indicates thyroid disorders?

Answer 7

Brady/tachycardia
Cold/heat intolerance
Constipation/diarrhea

Question 8

What does hypokalemia indicate?

Answer 8

Aldosteronism

Question 9

What are the obstructive sleep apnea symptoms?

Answer 9

Apneic events during sleep
Daytime sleepiness
Snoring

Question 10

What are pheochromocytoma symptoms?

Answer 10

Headaches
Orthostatic hypotension
Palpitations
Sweating
Syncope
Flushing

Question 11

What are Cushing syndrome symptoms?

Answer 11

Buffalo hump
Central obesity
Moon face
Striae

Question 12

Most common cause of secondary hypertension in children/adolescents?

Answer 12

Renal parenchymal disease

Coarctation of the aorta

Question 13

Percentage of children with hypertension that have a secondary cause?

Answer 13

70-85%

Question 14

Adolescents:

Answer 14

10-15%

Question 15

Young adults:

Answer 15

5%

Question 16

Middle-aged adults:

Answer 16

8-12%

Question 17

Older adults:

Answer 17

17%

Question 18

Most common cause of secondary hypertension in young adults?

Answer 18

Thyroid dysfunction
Fibromuscular dysplasia
Renal parenchymal disease

Question 19

Most common cause in middle-aged adults?

Answer 19

Aldosteronism
Thyroid dysfunction
OSA
Cushing syndrome
Pheochromocytoma

Question 20

Most common cause in older adults?

Answer 20

Atherosclerotic renal artery stenosis
Renal failure
Hypothyroidism

Question 21

Statistics of coarctation of the aorta:

Answer 21

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

Question 22

What is fibromuscular dysplasia and what does it typically affect?

Answer 22

Narrowing of the artery typically the renal arteries decreasing renal perfusion

Question 23

What is a sign of renal fibromuscular dysplasia?

Answer 23

High-pitched holosystolic renal artery bruit

Question 24

Fibromuscular dysplasia is the most common cause of secondary HTN in which age group?

Answer 24

Young adults

Question 25

What is primary aldosteronism?

Answer 25

Hyperaldosteronism

Question 26

Most common cause of resistant HTN?

Answer 26

Aldosteronism

Question 27

What should lead you to suspect renal artery stenosis?

Answer 27

Development of HTN after age 50
Known atherosclerosis elsewhere
Unexplained renal insufficiency
Rapid deterioration of the kidneys