Secondary hypertension
Secondary hypertension | |
---|---|
Classification and external resources | |
ICD-10 | I15. |
ICD-9 | 405 |
Secondary hypertension (or, less commonly, inessential hypertension) is a type of hypertension which by definition is caused by an identifiable underlying secondary cause. It is much less common than the other type, called essential hypertension, affecting only 5% of hypertensive patients. It has many different causes including endocrine diseases, kidney diseases, and tumors. It also can be a side effect of many medications.
Contents
- 1 Types
- 1.1 Renovascular hypertension (I15.0)
- 1.2 Hypertension secondary to other renal disorders (I15.1)
- 1.3 Hypertension secondary to endocrine disorders (I15.2)
- 1.4 Other secondary hypertension (I15.8)
- 1.5 Adrenal
- 1.6 Kidney
- 1.7 Medication side effects
- 1.8 Pregnancy
- 1.9 Sleep disturbances
- 1.10 Arsenic exposure
- 1.11 Potassium deficiency
- 2 Diagnosis
- 3 References
- 4 External links
Types
Renovascular hypertension (I15.0)
It has two main causes: fibromuscular dysplasia and atheromatous stenosis.
- See main article at Renovascular hypertension.
Hypertension secondary to other renal disorders (I15.1)
- Chronic renal failure
- Kidney disease / renal artery stenosis: the normal physiological response to low blood pressure in the renal arteries is to increase cardiac output (CO) to maintain the pressure needed for glomerular filtration. Here, however, increased CO cannot solve the structural problems causing renal artery hypotension, with the result that CO remains chronically elevated.
- Renal segmental hypoplasia (Ask-Upmark kidney)
Hypertension secondary to endocrine disorders (I15.2)
- Pheochromocytoma - caused by an excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction
- Hyperaldosteronism (Conn's syndrome) - idiopathic hyperaldosteronism, liddle's syndrome (also called pseudoaldosteronism), glucocorticoid remediable aldosteronism
- Cushing's syndrome - an excessive secretion of glucocorticoids causes the hypertension
- Hyperparathyroidism
- Acromegaly
- Hyperthyroidism
- Hypothyroidism
Other secondary hypertension (I15.8)
- Hormonal contraceptives
- Neurologic disorders
- Obstructive sleep apnea
- Liquorice (when consumed in excessive amounts)
- Scleroderma
- Neurofibromatosis
- Pregnancy: unclear etiology.
- Cancers: tumours in the kidney can operate in the same way as kidney disease. More commonly, however, tumors cause inessential hypertension by ectopic secretion of hormones involved in normal physiological control of blood pressure.
- Drugs: In particular, alcohol, nasal decongestants with adrenergic effects, NSAIDs, MAOIs, adrenoceptor stimulants, and combined methods of hormonal contraception (those containing ethinyl-estradiol) can cause hypertension while in use.
- Malformed aorta, slow pulse, ischemia: these cause reduced blood flow to the renal arteries, with physiological responses as already outlined.
- Aortic valve disease: unclear etiology.
- Coarcation of the aorta
- Atherosclerosis
- Anemia: unclear etiology.
- Fever: unclear etiology.
- White coat hypertension, that is, elevated blood pressure in a clinical setting but not in other settings, probably due to the anxiety some people experience during a clinic visit.
- Perioperative hypertension is development of hypertension just before, during or after surgery. It may occur before surgery during the induction of anesthesia; intraoperatively e.g. by pain-induced sympathetic nervous system stimulation; in the early postanesthesia period, e.g. by pain-induced sympathetic stimulation, hypothermia, hypoxia, or hypervolemia from excessive intraoperative fluid therapy; and in the 24 to 48 hours after the postoperativ period as fluid is mobilized from the extravascular space. In addition, hypertension may develop perioperatively because of discontinuation of long-term antihypertensive medication.[1]
Adrenal
A variety of adrenal cortical abnormalities can cause hypertension, In primary aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.[2] Another related disorder that causes hypertension is apparent mineralocorticoid excess syndrome which is an autosomal recessive disorder that results from mutations in the gene encoding 11β-hydroxysteroid dehydrogenase, an enzyme that normally inactivates circulating cortisol to the less-active metabolite cortisone.[3] At high concentrations cortisol can cross-react and activate the mineralocorticoid receptor, leading to aldosterone-like effects in the kidney, causing hypertension.[4] This effect can also be produced by prolonged ingestion of liquorice (which can be of potent strength in liquorice candy), by causing inhibition of the 11β-hydroxysteroid dehydrogenase enzyme and likewise leading to secondary apparent mineralocorticoid excess syndrome.[5][6][7] Frequently, if liquorice is the cause of the high blood pressure, a low blood level of potassium will also be present.[6] Yet another related disorder causing hypertension is glucocorticoid remediable aldosteronism, which is an autosomal dominant disorder in which the increase in aldosterone secretion produced by ACTH is no longer transient, causing of primary hyperaldosteronism, the Gene mutated will result in an aldosterone synthase that is ACTH-sensitive, which is normally not.[8][9][10][11][12] GRA appears to be the most common monogenic form of human hypertension.[13] Compare these effects to those seen in Conn's disease, an adrenocortical tumor which causes excess release of aldosterone,[14] that leads to hypertension.[15][16][17]
Another adrenal related cause is Cushing's syndrome which is a disorder caused by high levels of cortisol. Cortisol is a hormone secreted by the cortex of the adrenal glands. Cushing's syndrome can be caused by taking glucocorticoid drugs, or by tumors that produce cortisol or adrenocorticotropic hormone (ACTH).[18] More than 80% of patients with Cushing's syndrome develop hypertension.,[19] which is accompanied by distinct symptoms of the syndrome, such as central obesity, buffalo hump, moon face, sweating, hirsutism and anxiety.[20]
Kidney
Other well known causes include diseases of the kidney. This includes diseases such as polycystic kidney disease which is a cystic genetic disorder of the kidneys, PKD is characterized by the presence of multiple cysts (hence, "polycystic") in both kidneys, can also damage the liver, pancreas, and rarely, the heart and brain.[21][22][23][24] It can be autosomal dominant or autosomal recessive, with the autosomal dominant form being more common and characterized by progressive cyst development and bilaterally enlarged kidneys with multiple cysts, with concurrent development of hypertension, renal insufficiency and renal pain.[25] Or chronic glomerulonephritis which is a disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.[26][27][28] Hypertension can also be produced by diseases of the renal arteries supplying the kidney. This is known as renovascular hypertension; it is thought that decreased perfusion of renal tissue due to stenosis of a main or branch renal artery activates the renin-angiotensin system.[29][30][31] also some renal tumors can cause hypertension. The differential diagnosis of a renal tumor in a young patient with hypertension includes Juxtaglomerular cell tumor, Wilms' tumor, and renal cell carcinoma, all of which may produce renin.[32]
Neuroendocrine tumors are also a well known cause of secondary hypertension. Pheochromocytoma[33] (most often located in the adrenal medulla) increases secretion of catecholamines such as epinephrine and norepinephrine, causing excessive stimulation of adrenergic receptors, which results in peripheral vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites (vanillylmandelic acid).
Medication side effects
Certain medications, especially NSAIDs (Motrin/Ibuprofen) and steroids can cause hypertension.[34][35][36][37][38] High blood pressure that is associated with the sudden withdrawal of various antihypertensive medications is called rebound hypertension.[39][40][41][42][43][44][45] The increases in blood pressure may result in blood pressures greater than when the medication was initiated. Depending on the severity of the increase in blood pressure, rebound hypertension may result in a hypertensive emergency. Rebound hypertension is avoided by gradually reducing the dose (also known as "dose tapering"), thereby giving the body enough time to adjust to reduction in dose. Medications commonly associated with rebound hypertension include centrally-acting antihypertensive agents, such as clonidine[46] and beta-blockers.[45]
Pregnancy
Few women of childbearing age have high blood pressure, up to 11% develop hypertension of pregnancy.[47] While generally benign, it may herald three complications of pregnancy: pre-eclampsia, HELLP syndrome and eclampsia. Follow-up and control with medication is therefore often necessary.[48][49]
Sleep disturbances
Another common and under-recognized sign of hypertension is sleep apnea,[50][51] which is often best treated with nocturnal nasal continuous positive airway pressure (CPAP), but other approaches include the Mandibular advancement splint (MAS), UPPP, tonsillectomy, adenoidectomy, septoplasty, or weight loss. Another cause is an exceptionally rare neurological disease called Binswanger's disease, causing dementia; it is a rare form of multi-infarct dementia, and is one of the neurological syndromes associated with hypertension.[52]
Arsenic exposure
Because of the ubiquity of arsenic in ground water supplies and its effect on cardiovascular health, low dose arsenic poisoning should be inferred as a part of the pathogenesis of idiopathic hypertension. Idiopathic and essential are both somewhat synonymous with primary hypertension. Arsenic exposure has also many of the same signs of primary hypertension such as headache, somnolence, [53] confusion, proteinuria [54] visual disturbances, and nausea and vomiting [55]
Potassium deficiency
Due to the role of intracellular potassium in regulation of cellular pressures related to sodium, establishing potassium balance has been shown to reverse hypertension. [56]
Diagnosis
The ABCDE mnemonic can be used to help determine a secondary cause of hypertension
- A: Accuracy, Apnea, Aldosteronism
- B: Bruits, Bad Kidney
- C: Catecholamines, Coarctation of the Aorta, Cushing's Syndrome
- D: Drugs, Diet
- E: Erythropoietin, Endocrine Disorders [57]
References
Cite error: Invalid <references>
tag;
parameter "group" is allowed only.
<references />
, or <references group="..." />
External links
es:Hipertensión secundaria- ↑ Varon J, Marik PE (2008). "Perioperative hypertension management". Vasc Health Risk Manag. 4 (3): 615–27. PMC 2515421 Freely accessible. PMID 18827911.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ 6.0 6.1 Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ McMahon GT, Dluhy RG (2004). "Glucocorticoid-remediable aldosteronism". Cardiology in Review. 12 (1): 44–8. doi:10.1097/01.crd.0000096417.42861.ce. PMID 14667264. Retrieved 2009-06-19.
- ↑ Ziaja J, Cholewa K, Mazurek U, Cierpka L (2008). "[Molecular basics of aldosterone and cortisol synthesis in normal adrenals and adrenocortical adenomas]". Endokrynologia Polska (in Polish). 59 (4): 330–9. PMID 18777504.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Kumar, Abbas, Fausto. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier-Saunders; New York, 2005.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Masoumi A, Reed-Gitomer B, Kelleher C, Schrier RW (2007). "Potential pharmacological interventions in polycystic kidney disease". Drugs. 67 (17): 2495–510. doi:10.2165/00003495-200767170-00004. PMID 18034588.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Simone Rossi, ed. (2006). Australian medicines handbook 2006. Adelaide: Australian Medicines Handbook Pty Ltd. ISBN 0-9757919-2-3.[page needed]
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Mackenzie IS, Rutherford D, MacDonald TM (2008). "Nitric oxide and cardiovascular effects: new insights in the role of nitric oxide for the management of osteoarthritis". Arthritis Research & Therapy. 10 Suppl 2: S3. doi:10.1186/ar2464. PMC 2582806 Freely accessible. PMID 19007428. Retrieved 2009-06-18.
- ↑ Berenbaum F (2008). "New horizons and perspectives in the treatment of osteoarthritis". Arthritis Research & Therapy. 10 Suppl 2: S1. doi:10.1186/ar2462. PMC 2582808 Freely accessible. PMID 19007426. Retrieved 2009-06-18.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ 45.0 45.1 Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ van Zwieten PA, Thoolen MJ, Timmermans PB (1984). "The hypotensive activity and side effects of methyldopa, clonidine, and guanfacine". Hypertension. 6 (5 Pt 2): II28–33. PMID 6094346.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Pack AI, Gislason T (2009). "Obstructive sleep apnea and cardiovascular disease: a perspective and future directions". Progress in Cardiovascular Diseases. 51 (5): 434–51. doi:10.1016/j.pcad.2009.01.002. PMID 19249449. Retrieved 2009-06-20.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Arsenic trioxide drugs dot com
- ↑ atsdr-medical management guidelines for arsenic trioxide
- ↑ Arsenic Author: Frances M Dyro, MD, Chief of the Neuromuscular Section, Associate Professor, Department of Neurology, New York Medical College, Westchester Medical Center
- ↑ Can Med Assoc J. 1928 March; 18(3): 281–285. PMCID: PMC1710082 The Use of Sodium Chloride, Potassium Chloride, Sodium Bromide, and Potassium Bromide in Cases of Arterial Hypertension which are Amenable to Potassium Chloride W. L. T. Addison
- ↑ "Secondary Hypertension". Hypertension Etiology & Classification - Secondary Hypertension. Armenian Medical Network. 2006. Retrieved 2007-12-02. Text " Williams B et al.; British Hypertension Society; Michael Sutters, MD " ignored (help)
- 2Fix
- Use dmy dates from September 2010
- Articles with invalid date parameter in template
- Kidney diseases
- Hypertension
- Cardiology
- Cardiovascular diseases
- Pages with script errors
- Pages with broken file links
- Pages using citations with accessdate and no URL
- CS1 maint: Multiple names: authors list
- CS1 maint: Unrecognized language
- Wikipedia articles needing page number citations from September 2010
- Pages with citations using unnamed parameters