Causes of resistant hypertension compliance improper bp measurement. Approach to a case of secondary hypertension sciencedirect. Most hypertension cannot be cured, only controlled. Hypertension 14090 3 medications including diuretic at max tolerated doses aha uncontrolled on 3 medications controlled on 4 medications.
Overview secondary htn accounts for 510% of other cases and represents potentially curable disease often overlooked and underscreened controversy over screening and treatment in some cases 4. Secondary hypertension is a common cause of hypertension in adults, occurring in about 10% of hypertensive patients. After clinic measurements are confirmed, secondary causes of hypertension require consideration. Determine appropriate secondary ischemic stroke prevention including considerations for antithrombotic therapy, lipidlowering therapy, and hypertension management 2. The list of secondary causes is well documented, and includes conditions that activate the reninangiotensinaldosterone system ras, ie. Evaluation and treatment of high blood pressure 3 provides a classification of blood. Secondary hypertension is elevated blood pressure that results from an underlying, iden tifiable, often correctable cause. Only about 5 to 10 percent of hypertension cases are thought to result. Januar 2020 2 clinical information presented may include patient. There are many known conditions that can cause secondary hypertension.
Pdf mr ali, aged 55 years, visited you for a scheduled followup for his. Secondary hypertension workup the soapnote project. Newonset or uncontrolled hypertension in adults referral not necessary no benefit refer to clinician with specific expertise class iib yes no screening not indicated no benefit screen for secondary hypertension class i see table yes no positive screening test conditions p resistant induced hypertension v zc v v. Pediatric pediatrics adults national kidney foundation. Fewer than 10% of patients have secondary hypertension. Diagnosis and treatment of causes of secondary hypertension. In about 10% of people, high blood pressure is caused by another disease. Risk factors for cardiovascular disease subclinical target organ damage definitive target organ damage metabolic syndrome criteria. Her past medical records state that she has a history of hypertension which is not well controlled. Apply the above knowledge to patient cases to make appropriate clinical. But, about 5 to 10% of cases of hypertension are due to secondary. Secondary hypertension workup by tamer moustafa abe elghany md, fesc 3. It is much less common than the other type, called essential hypertension, affecting only 5% of hypertensive patients. Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause.
Diagnosing secondary hypertension american family physician. Regardless of the cause, arterial pressure becomes elevated either due to an increase in cardiac output, an increase in systemic vascular resistance, or both. An approach to the young hypertensive patient scielo sa. His family history is significant for hypertension in multiple. Secondary hypertension has an identifiable cause whereas primary hypertension has no known cause i. Rule out identifiable causes of hypertension, and 3. Secondary prevention of stroke questions and answers. A secondary etiology may be suggested by symptoms e.
Canadian hypertension educationprogram guidelines khan et al. The possibility of secondary hypertension should be considered in the diagnosis and treatment of all hypertensive patients. Secondary hypertension work up linkedin slideshare. Common causes of secondary hypertension include renal parenchymal disease, renovascular hypertension, conn syndrome and pheochromocytoma. The patient does not appear to have another cause of. Secondary hypertension in adults pubmed central pmc. Apr 25, 2018 pulmonary hypertension ph, defined as a mean pulmonary arterial pressure greater than 25 mm hg at rest or greater than 30 mm hg during exercise, is often characterized by a progressive and sustained increase in pulmonary vascular resistance that eventually may lead to right ventricular rv failure. Screening for secondary hypertension colors correspond to class of recommendation in table 1.
College of radiologys acr manual on contrast media version 7. However, a small percentage of people with this type of high blood pressure may be able to get rid of it. In the absence of other clinical clues, an initial workup for hypertension for middleaged adults age 40. Inconclusive evidence to lower sodium workup of patients with resistive hypertension should be a twostep approach table 3. Causes of secondary hypertension with clinical indications and diagnostic. The only difference is that we do less cardiac workup for most patients than thos\. We do not recommend an extensive workup for all newly diagnosed young. Workup key highlights from the recommended guideline the three goals of the workup are. Review ischemic stroke risk factors, etiologies, and workup b. Secondary forms of hypertension are rare and the origin could be.
Recognition, diagnosis and treatment of secondary causes of hypertension lead to good. Blood pressure bp thresholds and recommendations for treatment and. Outside the scope of this guideline is the management of secondary causes of htn, accelerated htn, acute htn in emergency. The hypercoagulable states are a group of acquired and inherited disorders that increase the risk of abnormal development of blood clots. In the absence of other clinical clues, an initial workup for hypertension for middleaged adults age 4064 years may include. Secondary hypertension occurs in a significant proportion of adult patients 10%. The evaluation of a patient with hypertension depends upon the likely cause and the degree of difficulty in achieving acceptable blood pressure control since many forms of secondary hypertension cause treatmentresistant hypertension 1. Provider education is key in dealing with this issue. When to admit and workup jen simpson, md neurohospitalist. Secondary prevention of hypertension occurs when your blood pressure is within prehypertension limits 1209 systolic 8089 diastolic.
Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. Treatment of secondary forms of hypertension differs widely. Focused practice in hospital medicine maintenance of certification moc examination blueprint. Conditions under which children issues in diagnosis and treatment article pdf available in primary care clinics in office practice 414 december 2014 with 152 reads how we measure reads. In order to confirm hypertension in the pediatric population, it has been suggested that. If that is the case, it is called secondary hypertension. Secondary hypertension is systemic hypertension due to an underlying. It is important to identify these conditions as they may be able to be treated, allowing the blood pressure to return to normal or near normal levels. Download fulltext pdf download fulltext pdf download fulltext pdf resistant hypertension workup and approach to treatment article pdf available december 2010 with 747 reads. Likely etiologies of secondary hypertension are different in children compared with. Hypertension diagnosis and management effective date. Evaluation and management of hypertension in the elderly.
Hypertension is the single biggest contributor to the global burden of disease, and is the most common chronic medical condition presenting to primary care physicians in singapore. When hypertension is caused by another condition or disease process, it is called secondary hypertension. The fourth report on the diagnosis, evaluation, and treatment. Hypertension high blood pressure lab tests online au. Hypertension affects approximately 75 million adults in the united states and is a. The 2014 canadian hypertension education program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Secondary hypertension in the pediatric population ashley m. Pdf resistant hypertension workup and approach to treatment.
However, a small percentage of people with this type of high blood pressure may be able to get rid of it once. Secondary hypertension accounts for approximately 510% of all cases of hypertension, with the remaining being primary hypertension. Pulmonary hypertension ph is high blood pressure in the lung circulation. In patients refractory to the above treatment, few upper airway. Jan 01, 2003 secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause.
The patient does not appear to have another cause of secondary hypertension such as primary. The fourth report on the diagnosis, evaluation, and. Hypertension case study a 55 year old woman is admitted to the impatient rehabilitation unit with a lacunar infarct in the right thalamicsubcortical area. Pdf secondary hypertension occurs in 510% of cases in the patient. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn in adults aged. Mar, 2014 secondary hypertension workup by tamer moustafa abe elghany md, fesc 3. Resistant hypertension a 56yearold man with type 2 diabetes mellitus is referred for blood pressure evaluation. Secondary hypercoagulable state is often under documented and underreported. Hypercoagulable state primary or secondary, when documented in the medical record is a cc and can, therefore, impact the length of stay, reimbursement, severity of illness and risk of mortality. Assess target organ damage investigate beyond the routine based on your index of suspicion scope.
Northwestern university feinberg school of medicine. It can occur without a known cause, or it can be caused by another lung disease or be secondary to abnormalities in the left side of the heart. Prediction of primary vs secondary hypertension in children. Secondary prevention includes screening for disease progression and taking preventative measures in order to limit further complications current nursing, 2012. Understand secondary causes of resistant hypertension learn basic strategies for the management of patients with resistant hypertension health care, education and research hypertension 101 jnc 7 jama 2003. Health professionals involved in the care of patients with hypertension. Secondary hypertension hypertension may also be due to an identifiable disease. How do i investigate suspected secondary hypertension. High blood pressure also referred to as hbp, or hypertension is when your blood pressure, the force of blood flowing through your blood vessels, is consistently too high.
It has many different causes including endocrine diseases, kidney diseases, and tumors. Patients likely to have essential idiopathic or primary hypertension undergo a relatively limited. Differential diagnosis and basic principles of treatment. Tumor necrosis factoralpha antagonist etanercept decreases blood pressure and protects the kidney in a mouse model of systemic lupus erythematosus. Secondary hypertension or, less commonly, inessential hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. Consensus documents developed in collaboration with the american. Hypertension management controversies in the elderly patient. In such cases, when the root cause is treated, blood pressure.
While the majority of patients have essential hypertension that does not have an identifiable cause, it is important to recognise secondary causes of hypertension table i, as. Pdf secondary hypertension, issues in diagnosis and treatment. If this does not detect a cause and secondary hypertension is still suspected, echocardiography and 24hour urine collection for cortisol and fractionated metanephrines could be performed. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known. It is important to identify these conditions as they may be able to be treated, allowing the blood pressure to return to normal or. This form of high blood pressure is called secondary hypertension.
1563 435 643 1102 995 346 427 1073 39 31 1369 783 970 951 1003 835 692 1461 51 1372 679 717 204 550 927 797 1230 1298 802 1102 808 794