• Secondary causes of hypertension

    by  • 15/08/2013 • Cardiology

    Definition

    Where blood pressure elevation is the result of a specific and potentially treatable cause.

    Incidence

    10% of hypertension cases.

    Aetiology – cause, risk factors

    1. Renal disease (80% of secondary hypertension) – impair volume regulation and/or activate the renin-angiotensin-aldosterone system. Sodium and water retention, but there can be inappropriate elevation of plasma renin levels.
      1. o Chronic glomerulonephritis
      2. o Chronic pyelonephritis
      3. o Polycystic renal disease
      4. o Renal artery stenosis

     

    1. Endocrine disease – Often of the adrenal cortex, and associated with oversecretion of aldosterone, cortisol and/or catecholamines.
      1. o Cushings syndrome
      2. o Conns syndrome
      3. o Adrenal hyperplasia
      4. o Phaeochromocytoma
      5. o Acromegaly
      6. o Corticosteroid therapy

     

    1. Congenital disease
      1. o Coarctation of the aorta

     

    1. Neurologic disease
      1. o Raised intracranial pressure
      2. o Brainstem lesions

     

    1. Pregnancy – 8-10% of pregnancies result in hypertension.
      1. o Pre-eclampsia

     

    1. Drugs
      1. o Oral contraceptives – Which may raise blood pressure via renin-angiotensin-aldosterone activation and hyperinsulinaemia.
      2. o NSAIDs
      3. o Steroids
      4. o Carbenoxolone
      5. o Liquorice
      6. o Sympathomimetics
      7. o Vasopressin   
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