Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Secondary hypertension refers to high blood pressure caused by an identifiable underlying condition. Unlike essential (primary) hypertension, these cases may be curable if the cause is treated. Although less common (β5β10% of cases), recognising clues is important because delayed diagnosis can lead to preventable complications.
Cause | Clues | Key Tests & Management |
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π©Έ Renal Artery Stenosis | Resistant HTN, abdominal bruit, β creatinine after ACEi/ARB | Doppler US, CT/MR angiography β Angioplasty Β± stent, avoid ACEi/ARB if bilateral |
β‘ Primary Aldosteronism (Connβs) | HTN + hypokalaemia, weakness, cramps | Aldosterone:renin ratio, adrenal CT β Spironolactone/eplerenone, adrenalectomy if unilateral |
π₯ Phaeochromocytoma | Paroxysmal HTN, headache, palpitations, sweating | Plasma/urinary metanephrines, MRI/CT β Alpha-blockade β Ξ²-blocker β surgery |
π Cushingβs Syndrome | Central obesity, moon face, striae, proximal weakness | 24h urinary cortisol, dex suppression test β Surgery; Β± ketoconazole/metyrapone |
π« Coarctation of the Aorta | HTN in arms, weak femoral pulses, rib notching | Echo, CT/MR angiography β Surgical repair or balloon angioplasty |
π¦ Thyroid Disease | Hyper: tachy, weight loss; Hypo: brady, weight gain | TFTs Β± US β Hyper: carbimazole/RAI/surgery; Hypo: levothyroxine; Ξ²-blockers for symptoms |
π΄ Obstructive Sleep Apnoea | Loud snoring, daytime sleepiness, witnessed apnoeas | Polysomnography β CPAP, weight loss, avoid alcohol/sedatives, surgery if refractory |
Secondary hypertension is rare but potentially curable. In UK practice, NICE recommends investigation when there are clinical clues (young age, resistant HTN, hypokalaemia, or suggestive symptoms). Always confirm diagnosis with appropriate tests before committing to invasive treatment.