Secondary hypertension
Secondary hypertension is high blood pressure from an identifiable, often correctable cause, such as primary aldosteronism, renal or renovascular disease, obstructive sleep apnea, or endocrine tumors. It should be suspected with resistant, early-onset, or abrupt hypertension, and identifying the cause can cure or greatly improve control.
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What this article covers
- Overview
Definition: secondary hypertension is elevated blood pressure caused by a specific, identifiable, and often correctable underlying condition, rather than primary (essential) hypertension.
- Epidemiology
A minority of hypertension overall, but far more common in resistant and young-onset cases.
- Risk factors
Resistant or difficult-to-control hypertension.
- Pathophysiology
Mineralocorticoid excess: primary aldosteronism causes sodium retention, volume expansion, and potassium loss.
- Clinical features
Often the same as essential hypertension (asymptomatic), but with cause-specific clues.
- Differential diagnosis
Essential hypertension: no identifiable cause, distinguished by negative cause-specific screening and typical onset in middle age (Essential hypertension).
- Diagnosis
Establish by targeted testing directed at the suspected cause, prompted by clinical clues: the diagnostic basis is recognizing features that raise suspicion (resistance, young or abrupt onset…
- Management
First-line, treat the specific underlying cause: for example a mineralocorticoid antagonist (spironolactone 25 to 50 mg PO daily) or adrenalectomy for primary aldosteronism, revascularization for…
- Complications
Accelerated target-organ damage (stroke, heart failure, kidney disease).
- Prognosis
Potentially curable or markedly improved when the cause is corrected.
- Prevention
Screen for secondary causes in resistant, early-onset, or severe hypertension.
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Related articles
- Essential hypertension
Essential (primary) hypertension is chronically elevated blood pressure without an identifiable secondary cause, the overwhelming majority of hypertension. It is a leading modifiable driver of stroke, heart failure, and kidney disease, and management combines lifestyle change with staged pharmacotherapy to a target usually below 130/80 mmHg.
- Resistant hypertension
Resistant hypertension is blood pressure that remains above target despite three optimally dosed antihypertensives including a diuretic, or that requires four or more drugs. Evaluation excludes pseudoresistance and secondary causes, and treatment optimizes the regimen, emphasizes a mineralocorticoid antagonist, and addresses lifestyle and adherence.
- Hypertensive emergency
Hypertensive emergency is severe hypertension (usually above 180/120 mmHg) with acute target-organ damage such as encephalopathy, stroke, acute heart failure, myocardial ischemia, aortic dissection, or acute kidney injury. It requires controlled intravenous blood pressure reduction, with the target and pace determined by the specific end-organ involved.
- Coarctation of the aorta
Coarctation of the aorta is a congenital narrowing of the aorta, usually just distal to the left subclavian artery, causing upper-limb hypertension with reduced, delayed lower-limb pulses. Critical neonatal coarctation is duct-dependent, while older children and adults present with hypertension; treatment is surgical or catheter-based repair.