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Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Secondary hypertension is high blood pressure caused by a medical condition that affects the kidneys, arteries, heart, or endocrine system. Diabetes mellitus is among these conditions. Secondary hypertension can also occur during pregnancy. Proper treatment often is able to control the underlying condition and the hypertension itself, reducing risks of serious complications such as heart disease, kidney failure, and stroke. Resistant hypertension exists when BP remains higher than desired even when three different antihypertensive agents are being used. This type of hypertension causes more complications and deaths than other types. The hypertension that develops before or during pregnancy has its own factors that must be addressed.
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone, Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope, Alberto Zanchetti, Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stéphane Laurent, Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka, Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans, Ileana Desormais
Secondary hypertension is hypertension due to an identifiable cause, which may be treatable with an intervention specific to the cause. A high index of suspicion and early detection of secondary causes of hypertension are important because interventions may be curative, especially in younger patients [e.g. corrective surgery for aortic coarctation, renal angioplasty in younger patients with renal artery fibromuscular dysplasia, reversal of an endocrine cause of hypertension (e.g. by removal of an adrenal adenoma), or drug treatment of a monogenic disorder affecting a specific drug-sensitive ion channel (e.g. selective use of amiloride in Liddle’s syndrome)]. Interventions that treat the cause of secondary hypertension later in life are less likely to be curative (i.e. remove the need for antihypertensive medication) because longstanding hypertension results in vascular and other organ damage that sustains the elevated BP, but intervention is still important because it will often result in much better BP control with less medication.
The circulatory system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Secondary hypertension is elevated blood pressure that is caused by some identifiable factor. Secondary hypertension likely accounts for less than 10% of all cases of hypertension. Unlike primary hypertension, which requires life-long management, forms of secondary hypertension may be potentially cured if the causative factor is identified and removed. For example, a patient with renal artery stenosis or narrowing may experience secondary hypertension because the reduced renal blood flow will lead to excess activation of the renin-angiotensin-aldosterone system (RAAS). If the stenosis is reversed and renal blood flow restored to normal, it is likely that the secondary hypertension in that patient will resolve. Table 6.14 lists some possible factors that may cause secondary hypertension.
Left ventricular long-axis ultrasound strain (GLS) is an ideal indicator for patients with anti-hypertension treatment
Published in Clinical and Experimental Hypertension, 2022
Tingting Wu, Lulu Zheng, Saidan Zhang, Lan Duan, Jing Ma, Lihuang Zha, Lingfang Li
The Research Ethics Committee of the Xiangya Hospital of Central South University had approved this study. All participating members had carefully read and signed informed consent. All enrolled members were divided into three groups, including 1) hypertensive treatment experimental group: 56 patients with newly diagnosed essential hypertension were followed up. 3) Healthy control group: 37 normal volunteers from the physical examination center were collected. The inclusion criteria are as follows: 1) Newly diagnosed essential hypertension. The diagnostic criteria included not taking antihypertensive drugs, measuring blood pressure three times on a different day, systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg (14); 2) 2) Patients with the previous diagnosis of hypertension and poor blood pressure control. After taking antihypertensive drugs, blood pressure was measured three times on a different day. The systolic blood pressure ≥140 mmHg and/or diastolic blood pressure≥90 mmHg. Moreover, exclusion criteria were as follows: 1) Patients have diagnosed as coronary heart disease; 2) Patients with various types of valvular heart disease; 3) Patients with various types of cardiomyopathy; 4) Patients with atrial fibrillation and atrial flutter; 5) Patients were previously diagnosed with primary and secondary pulmonary hypertension; 6) Patients with secondary hypertension; 7) LVEF <50% of patients with hypertension; 8) Patients with diabetes; 9) Patients with atrioventricular block of
Managing the elderly patient with hypertension: current strategies, challenges, and considerations
Published in Expert Review of Cardiovascular Therapy, 2020
Secondary hypertension should be suspected if there is new onset or uncontrolled hypertension in adults [27,39]. Screen for secondary hypertension if there is drug-resistant/induced hypertension, abrupt onset of hypertension, onset of hypertension in a person younger than 30 years, exacerbation of previously controlled hypertension, disproportionate target organ damage for the degree of hypertension, accelerated/malignant hypertension, onset of diastolic hypertension in elderly persons, or unprovoked or excessive hypokalemia [27,39]. Common causes of secondary hypertension include renal parenchymal disease, renovascular disease, primary aldosteronism, obstructive sleep apnea, and drug-or alcohol-induced hypertension [27]. Uncommon causes of secondary hypertension include pheochromocytoma/paraganglioma, Cushing’s syndrome, hypothyroidism, hyperthyroidism, aortic coarctation, primary hyperparathyroidism, congenital adrenal hyperplasia, mineralocorticoid excess syndromes, and acromegaly [27].
Insufficiency of the zona glomerulosa of the adrenal cortex and progressive kidney insufficiency following unilateral adrenalectomy – case report and discussion
Published in Blood Pressure, 2018
Joanna Kanarek-Kucner, Adrian Stefański, Rufus Barraclough, Tomasz Gorycki, Jacek Wolf, Krzysztof Narkiewicz, Michał Hoffmann
Transthoracic echocardiography revealed an enlarged left atrium (29 cm2), the remaining heart chambers were within normal ranges. The left ventricle did not show any signs of hypertrophy or contractile dysfunction; ejection fraction was 55%. The patient underwent thorough investigations for causes of secondary hypertension. A 24-hour urine collection found increased potassium excretion (149 mmol/24h; 25-125mmol/24h) with normal excretion of sodium, magnesium, calcium and phosphate ions. Other laboratory investigations included the following: diurnal cortisol rhythm, low-dose cortisol suppression test with 1 mg of dexamethasone (<28nmol/l), serum DHEA-S, androstenedione and ACTH levels, and a 24-hour urine collection for metoxycatecholamines; all were within normal ranges.