The ABCDEFs of Secondary Hypertension
- Apnea (OSA)
- Blood pressure measuring technique.
- Circulatory system problems: coarctation of the aorta, renal artery stenosis, and renal disease (glomerular disease & renal parenchymal disease).
- Drugs (medications and illicit drugs)
- Endocrine disorders
- Food or diet.
OSA=Obstructive sleep apnea; RAS=Renal Artery Stenosis (Renovascular disease); COA=Coarctation of the aorta. Primary aldosteronism = Conn’s syndrome
Alternative presentation: Adrenals and Kidneys; Breathing problems (OSA); Coarctation of the aorta; Drugs; Endocrine, Food or diet.
With RAS, bruit may be heard.
Endocrine Disorders that cause secondary hypertension
| Endocrine Gland | Hormones | Condition that causes Secondary Hypertension |
| Thyroid. | Thyroid hormone | Both Hypothyroidism and Hyperthyroidism can cause secondary HTN |
| Parathyroids | Parathyroid hormone | Hyperparathyroidism |
| Adrenals | -Aldosterone -Glucocorticoids -Catecholamines (E, NE) |
-Hyperaldosteronism (Conn’s) -Hypercortisolism (Cushing’s) -Pheochromocytoma |
| Pancreas | Insulin resistance | -Diabetes causes kidney damage > HTN |
| Kidneys | Erythropoietin | Erythropoietin-induced HTN. This is common in patients getting EPO. |
Other causes: Pregnancy, Obesity, Polycystic kidney disease
The causes of secondary HTN can be divided into:
- Things from the outside we do to ourselves: Drugs (steroids, etc), poor diet with high salt.
- Plumbing problem: COA, RAS, poor glomerular filtration in renovascular disease, possibly PCKD
- Endocrine problems: The endocrine hormones exert effects on the blood vessels that raise the blood pressure.
OSA mechanism from Mayo website:
“Sleep apnea. In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing you to not get enough oxygen.
Not getting enough oxygen may damage the lining of the blood vessel walls, which may make your blood vessels less effective in regulating your blood pressure. In addition, sleep apnea causes part of the nervous system to be overactive and release certain chemicals that increase blood pressure.”