Types Secondary hypertension

1 types

1.1 renal/kidney

1.1.1 renovascular hypertension (i15.0)
1.1.2 kidney
1.1.3 hypertension secondary other renal disorders (i15.1)


1.2 hypertension secondary endocrine disorders (i15.2)

1.2.1 adrenal


1.3 other secondary hypertension (i15.8)
1.4 medication side effects
1.5 pregnancy
1.6 sleep disturbances
1.7 arsenic exposure
1.8 potassium deficiency

types
renal/kidney
renovascular hypertension (i15.0)

it has 2 main causes: fibromuscular dysplasia , atheromatous stenosis. diabetes

see main article @ renovascular hypertension.

kidney

other known causes include diseases of kidney. includes diseases such polycystic kidney disease cystic genetic disorder of kidneys, pkd ,which characterized presence of multiple cysts (hence, polycystic ) in both kidneys, can damage liver, pancreas, , rarely, heart , brain. can autosomal dominant or autosomal recessive, autosomal dominant form being more common , characterized progressive cyst development , bilaterally enlarged kidneys multiple cysts, concurrent development of hypertension, renal insufficiency , renal pain. or chronic glomerulonephritis disease characterized inflammation of glomeruli, or small blood vessels in kidneys.

hypertension can produced diseases of renal arteries supplying kidney. known renovascular hypertension; thought decreased perfusion of renal tissue due stenosis of main or branch renal artery activates renin-angiotensin system.

also, renal tumors can cause hypertension. differential diagnosis of renal tumor in young patient hypertension includes juxtaglomerular cell tumor, wilms tumor, , renal cell carcinoma, of may produce renin.

hypertension secondary other renal disorders (i15.1)

chronic renal failure
kidney disease / renal artery stenosis – normal physiological response low blood pressure in renal arteries increase cardiac output (co) maintain pressure needed glomerular filtration. here, however, increased co cannot solve structural problems causing renal artery hypotension, result co remains chronically elevated.
renal segmental hypoplasia (ask-upmark kidney)

hypertension secondary endocrine disorders (i15.2)

neurogenic hypertension – excessive secretion of norepinephrine , epinephrine promotes vasoconstriction resulting chronic high activity of sympathoadrenal system, sympathetic nervous system , adrenal gland. specific mechanism involved increased release of stress hormones , epinephrine (adrenaline) , norepinephrine increase blood output heart , constrict arteries. people neurogenic hypertension respond poorly treatment diuretics underlying cause of hypertension not addressed.

pheochromocytoma – tumor results in excessive secretion of norepinephrine , epinephrine promotes vasoconstriction


hyperaldosteronism (conn s syndrome) – idiopathic hyperaldosteronism, liddle s syndrome (also called pseudoaldosteronism), glucocorticoid remediable aldosteronism
cushing s syndrome – excessive secretion of glucocorticoids causes hypertension
hyperparathyroidism
acromegaly
hyperthyroidism
hypothyroidism

adrenal

a variety of adrenal cortical abnormalities can cause hypertension, in primary aldosteronism there clear relationship between aldosterone-induced sodium retention , hypertension.

congenital adrenal hyperplasia, group of autosomal recessive disorders of enzymes responsible steroid hormone production, can lead secondary hypertension creating atypically high levels of mineralocorticoid steroid hormones. these mineralocorticoids cross-react aldosterone receptor, activating , raising blood pressure.

17 alpha-hydroxylase deficiency causes inability produce cortisol. instead, extremely high levels of precursor hormone corticosterone produced, of converted 11-deoxycorticosterone (doc), potent mineralocorticoid not clinically important in humans. doc has blood-pressure raising effects similar aldosterone, , abnormally high levels result in hypokalemic hypertension.
11β-hydroxylase deficiency, aka apparent mineralocorticoid excess syndrome, involves defect in gene 11β-hydroxysteroid dehydrogenase, enzyme inactivates circulating cortisol less-active metabolite cortisone. @ high concentrations cortisol can cross-react , activate mineralocorticoid receptor, leading aldosterone-like effects in kidney, causing hypertension. effect can produced prolonged ingestion of liquorice (which can of potent strength in liquorice candy), causing inhibition of 11β-hydroxysteroid dehydrogenase enzyme , likewise leading secondary apparent mineralocorticoid excess syndrome. frequently, if liquorice cause of high blood pressure, low blood level of potassium present. cortisol induced hypertension cannot explained activity of cortisol on aldosterone receptors. experiments show treatment spironolactone (an inhibitor of aldosterone receptor), not prevent hypertension excess cortisol. seems inhibition of nitric oxide synthesis may play role in cortisol induced hypertension.

yet related disorder causing hypertension glucocorticoid remediable aldosteronism, autosomal dominant disorder in increase in aldosterone secretion produced acth no longer transient, causing of primary hyperaldosteronism, gene mutated result in aldosterone synthase acth-sensitive, not. gra appears common monogenic form of human hypertension.

compare these effects seen in conn s disease, adrenocortical tumor causes excess release of aldosterone, leads hypertension.

another adrenal related cause cushing s syndrome disorder caused high levels of cortisol. cortisol hormone secreted cortex of adrenal glands. cushing s syndrome can caused taking glucocorticoid drugs, or tumors produce cortisol or adrenocorticotropic hormone (acth). more 80% of patients cushing s syndrome develop hypertension., accompanied distinct symptoms of syndrome, such central obesity, lipodystrophy, moon face, sweating, hirsutism , anxiety.

neuroendocrine tumors known cause of secondary hypertension. pheochromocytoma (most located in adrenal medulla) increases secretion of catecholamines such epinephrine , norepinephrine, causing excessive stimulation of adrenergic receptors, results in peripheral vasoconstriction , cardiac stimulation. diagnosis confirmed demonstrating increased urinary excretion of epinephrine , norepinephrine and/or metabolites (vanillylmandelic acid).

other secondary hypertension (i15.8)

hormonal contraceptives
neurologic disorders
obstructive sleep apnea
liquorice (when consumed in excessive amounts)
scleroderma
neurofibromatosis
pregnancy: unclear cause.
cancers: tumours in kidney can operate in same way kidney disease. more commonly, however, tumors cause inessential hypertension ectopic secretion of hormones involved in normal physiological control of blood pressure.
drugs: in particular, alcohol, nasal decongestants adrenergic effects, nsaids, maois, adrenoceptor stimulants, , combined methods of hormonal contraception (those containing ethinylestradiol) can cause hypertension while in use.

heavy alcohol use
steroid use
nicotine use.


malformed aorta, slow pulse, ischemia: these cause reduced blood flow renal arteries, physiological responses outlined.

aortic valve disease: unclear cause. aortic valve disease results longstanding hypertension according medical opinion. associated not cause of hypertension.
coarctation of aorta
atherosclerosis


anemia: unclear cause.
fever: unclear cause.
white coat hypertension, is, elevated blood pressure in clinical setting not in other settings, due anxiety people experience during clinic visit.
perioperative hypertension development of hypertension before, during or after surgery. may occur before surgery during induction of anesthesia; intraoperatively e.g. pain-induced sympathetic nervous system stimulation; in postanesthesia period, e.g. pain-induced sympathetic stimulation, hypothermia, hypoxia, or hypervolemia excessive intraoperative fluid therapy; , in 24 48 hours after postoperative period fluid mobilized extravascular space. in addition, hypertension may develop perioperatively because of discontinuation of long-term antihypertensive medication.

medication side effects

certain medications, including nsaids (motrin/ibuprofen) , steroids can cause hypertension. other medications include extrogens (such found in oral contraceptives high estrogenic activity), antidepressants (such venlafaxine), buspirone, carbamazepine, bromocriptine, clozapine, , cyclosporine. high blood pressure associated sudden withdrawal of various antihypertensive medications called rebound hypertension. increases in blood pressure may result in blood pressures greater when medication initiated. depending on severity of increase in blood pressure, rebound hypertension may result in hypertensive emergency. rebound hypertension avoided gradually reducing dose (also known dose tapering ), thereby giving body enough time adjust reduction in dose. medications commonly associated rebound hypertension include centrally-acting antihypertensive agents, such clonidine , methyl-dopa.

other herbal or natural products have been associated hypertension include ma huang, st john s wort, , licorice.

pregnancy

few women of childbearing age have high blood pressure, 11% develop hypertension of pregnancy. while benign, may herald 3 complications of pregnancy: pre-eclampsia, hellp syndrome , eclampsia. follow-up , control medication therefore necessary.

sleep disturbances

another common , under-recognized sign of hypertension sleep apnea, best treated nocturnal nasal continuous positive airway pressure (cpap), other approaches include mandibular advancement splint (mas), uppp, tonsillectomy, adenoidectomy, septoplasty, or weight loss. cause exceptionally rare neurological disease called binswanger s disease, causing dementia; rare form of multi-infarct dementia, , 1 of neurological syndromes associated hypertension.

arsenic exposure

because of ubiquity of arsenic in ground water supplies , effect on cardiovascular health, low dose arsenic poisoning should inferred part of pathogenesis of idiopathic hypertension. idiopathic , essential both synonymous primary hypertension. arsenic exposure has many of same signs of primary hypertension such headache, somnolence, confusion, proteinuria visual disturbances, , nausea , vomiting

potassium deficiency

due role of intracellular potassium in regulation of cellular pressures related sodium, establishing potassium balance has been shown reverse hypertension.