Essential or Secondary Hypertension

• What is secondary hypertension?


  Persistent high blood pressure caused by an identifiable underlying condition
• What percentage of hypertensive patients does secondary hypertension account for?


  1. 10%
• In which demographic should secondary hypertension be suspected?


  In younger people diagnosed with hypertension
• What are some causes of secondary hypertension?

  Primary renal disease, vascular disease, endocrine disorders, and certain medications
• What investigations are involved in diagnosing secondary hypertension?


  Blood tests, imaging, and specialized diagnostic tests
• What is the focus of management for secondary hypertension?


  Treating the underlying cause and controlling hypertension
• What are some long-term complications of untreated secondary hypertension?


  Cardiovascular disease, cerebrovascular disease, and chronic kidney disease
• What is the definition of secondary hypertension?


  Persistent elevation of blood pressure due to an identifiable cause
• What percentage of hypertension is attributable to primary hypertension?


  90-95%
• How does the pathophysiology of secondary hypertension vary?


  It depends on the underlying aetiology
• What are the broad categories for classifying secondary hypertension based on underlying causes?


  • Primary intrinsic renal disease
  • Vascular disease
  • Endocrine disease
  • Drugs
• What is the most common cause of secondary hypertension?


  Primary intrinsic renal disease
• What is chronic kidney disease's relationship with hypertension?


  Hypertension is a leading risk factor for chronic kidney disease
• What is renal artery stenosis?


  Unilateral or bilateral stenosis of renal arteries
• What can cause renal artery stenosis in older patients?

  Atherosclerosis
• What is aortic coarctation?


  Narrowing of the aortic arch near the remnants of the ligament arteriosum
• In which demographic is aortic coarctation more common?


  Children or adolescents
• What is Conn's disease?


  Primary hyperaldosteronism due to overproduction of aldosterone
• What blood test results are indicative of Conn's disease?


  Hypokalaemia and hypernatraemia
• What are the symptoms of Cushing's syndrome?


  Excess cortisol leading to increased sodium absorption and vascular sensitivity
• What is phaeochromocytoma?


  A rare primary adrenal tumor producing catecholamines
• What is the classical triad of symptoms for phaeochromocytoma?


  Sweating, headaches, and tachycardia
• What drugs can contribute to secondary hypertension?

  NSAIDs, corticosteroids, mineralocorticoids, and recreational drugs
• What are the symptoms and signs of hypertensive crisis/malignant hypertension?


  • Occipital pulsatile headache +/- visual disturbance
  • Bilateral retinal hemorrhages +/- exudates and papilloedema
  • Chest pain +/- signs of heart failure
  • Acute-onset confusion
• What symptoms may suggest the underlying cause of secondary hypertension?

  • Intrinsic renal disease: ballotable kidneys, signs of renal failure
  • Coarctation of the aorta: systolic murmur, radio-femoral delay
  • Cushing's syndrome: moon facies, abdominal striae
  • Conn's syndrome: weakness, tetany, cramps
  • Phaeochromocytoma: episodic headaches, sweating, tachycardia
• When should secondary hypertension be suspected?


  In younger patients with few comorbidities or severe hypertension resistant to treatment
• Why is it important to refer patients suspected of having secondary hypertension?


  Starting antihypertensives may interfere with further investigation
• What is the purpose of 24h ABPM in diagnosing hypertension?


  It provides a definitive diagnosis of hypertension
• What does a urine dipstick test for in the context of secondary hypertension?

  Evidence of glomerulonephritis, diabetic nephropathy, or CKD
• What is the significance of urinary metanephrines in secondary hypertension?


  It is used for the diagnosis of phaeochromocytoma
• What does an ECG look for in patients with secondary hypertension?


  Evidence of left ventricular hypertrophy (LVH)
• What blood test results suggest Conn's disease?


  Dyselectrolytaemia: hypokalaemia and hypernatraemia
• What imaging techniques are used in secondary hypertension diagnosis?


  Renal ultrasound, renal biopsy, and further imaging like CT or MRI
• What is the management approach for secondary hypertension?


  Treating the underlying disease and managing hypertension
• What are the complications of secondary hypertension?


  • Stroke
  • Aneurysm formation
  • Heart failure
  • Renal failure
  • Resistant hypertension if underlying disease is untreated
• What is the prognosis for treated secondary hypertension?


  It has a good prognosis
• What is the relationship between secondary hypertension and resistant hypertension?


  Secondary hypertension often leads to resistant hypertension unless the underlying disease is treated