Differential diagnosis and basic principles of treatment article pdf available in serbian journal of experimental and clinical research 174 december 2016 with 1,593. Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. Jun 06, 2019 secondary hypertension can be related to damaged kidneys or to an abnormal narrowing of one or both renal arteries. Kdigo 2017 clinical practice guideline update for the. Nov, 2017 john warner, md, president of the american heart association, interviews paul whelton, md, writing group chair for the 2017 hypertension clinical practice guidelines and the need for the guidelines, the new classification system, and what it means for clinicians and their patients.
Improving quality of care for patients with hypertension. Failure to recognise secondary causes can lead to resistant hypertension, cardiovascular complications or complications of the underlying condition. Hypothyroidism is a potentially important but overlooked cause of. Secondary hypertension has specific causes and is a complication of another health problem. Blood pressure classification by professional organization. Hypertension highlights 2017 health metrics american heart. Causes of secondary hypertension with clinical indications and diagnostic screening tests 2 of 3 10. Your doctor may not diagnose secondary hypertension based on only one higher than normal blood pressure reading. The most reliable screening test for primary aldosterone is the arr, although falsenegative and falsepositive results are possible. Secondary hypertension can be caused by myriad disease states and disorders, including endocrine disorders, renal disease, neurologic disorders, acute stress, and druginduced hypertension. It is much less common than the other type, called essential hypertension, affecting only 5% of hypertensive patients. This guideline is an update of the national heart, lung, and blood institute publication, the seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure jnc 7 and is a comprehensive resource for the clinical and public health practice communities.
However, even though more hospitalizations are secondary to hypertensive emergencies, mortality remains low, with an inhospital mortality of. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary hypertension has no clear cause and is thought to be linked to genetics, poor diet, lack of exercise and obesity. Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Secondary hypertension is a common cause of hypertension in adults, occurring in about 10% of hypertensive patients. Jul 11, 2017 when a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension. Methodology manual and policies from the accfaha task force on. John warner, md, president of the american heart association, interviews paul whelton, md, writing group chair for the 2017 hypertension clinical practice guidelines and the need for the guidelines, the new classification system, and what it means for clinicians and their patients. In order to treat secondary hypertension, your doctor will address the condition or disorder that is causing the hypertension adrenal gland disorder, kidney disease, sleep apnea, etc.
Aap guidelines for childhood hypertension highlights video an overview of the major changes in the 2017 guidelines, as well as implications for the practitioner. Correction of the causes of secondary forms of hypertension usually restores blood pressure to normal. Mar 22, 2018 systemic arterial hypertension is the most important modifiable risk factor for allcause morbidity and mortality worldwide and is associated with an increased risk of cardiovascular disease cvd. Clinical assessment of hypertension in children clinical. More than 50% of children who present with hypertension have a secondary cause. Pathophysiology of hypertension and hypertension management. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive. Use of antihypertensive medications among patients with a history of cvd or diabetes and without hypertension has been debated. Detection rate of secondary causes and coexisting diseases of hypertension was. George mansoor s volume on secondary hyper tension is an important contribution to the field of clinical hypertension and vascular diseases, since it brings up to date the numerous diagnostic and therapeutic advances in the evaluation for secondary types of hyper tension. Patients likely to have essential idiopathic or primary hypertension undergo a relatively limited evaluation because extensive laboratory. High blood pressure typically does not cause symptoms.
In young adults secondary hypertension is approximately 30%. Jul 22, 2019 secondary hypertension has specific causes and is a complication of another health problem. The 2017 guideline is a comprehensive guideline incorporating new information from studies regarding blood pressure bprelated risk of cardiovascular disease cvd, ambulatory bp monitoring abpm, home bp monitoring hbpm, bp thresholds to initiate antihypertensive drug treatment, bp goals of treatment, strategies to improve hypertension. When the kidneys blood supply is reduced by a narrowing called renal artery stenosis, the kidney produces high levels of a hormone called renin. Prevalence and associated risk factors of hypertension. In young patients, renal causes glomerulonephritis and coarctation of the aorta should be considered. The guidelines are intended to benefit physicians at primary, secondary and tertiary level.
Renal parenchymal diseasesprimary aldosteronismcushings syndromepheochromocytoma. His physical examination was notable for a blood pressure of 156104 mmhg and a body mass index of 25 kgm2. The aha issued guidelines in november 2017 that define hypertension as blood pressure that is. Secondary hypertension occurs in a significant proportion of adult patients 10%. Kdigo 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney diseasemineral and bone disorder ckdmbd 3 tables and supplementary material 6 kdigo executive committee 7 reference keys 8 ckd nomenclature 9 conversion factors 10 abbreviations and acronyms 11 notice 12 foreword. In most, hypertension is primary essential or idiopathic, but a subgroup of approximately 15% has secondary hypertension. Objective to evaluate the effect of antihypertensive treatment on secondary prevention of cvd events and allcause mortality among persons without. Secondary hypertension diagnosis and treatment mayo clinic. From the 2017 guideline for the prevention, detection, evaluation and management of high blood pressure in adults introduction 4. A secondary etiology may be suggested by symptoms e. Secondary hypertension is the most common form of hypertension seen in cats. Likely etiologies of secondary hypertension are different in children compared with. Secondary hypertension can also occur during pregnancy.
Antihypertensive treatment and secondary prevention of. Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. 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. Hypertension is the sustained elevation of systemic arterial blood pressure, most commonly defined as systolic blood pressure sbp. The renal arteries are the major blood vessels that bring blood to each kidney. Escesh guidelines on arterial hypertension management of. Only about 5 to 10 percent of hypertension cases are thought to result. How do i investigate suspected secondary hypertension. Identifying and treating that trigger condition should bring blood pressure down to normal levels.
Secondary hypertension differs from the usual type of high blood pressure primary hypertension or essential hypertension, which is often referred to simply as high blood pressure. Hypertension htn or ht, also known as high blood pressure hbp, is a longterm medical condition in which the blood pressure in the arteries is persistently elevated. Secondary hypertension in adults pubmed central pmc. This rare cause of secondary hypertension illustrates the importance of a methodical approach to the assessment of hypertension. Cardiology and aha accaha 2017 blood pressure guidelines lowered the threshold for the diagnosis of hypertension to an sbpdbp of 80 mm hg, which led to a new hypertension prevalence of 46% of u. In fact, up to 85 % of children with hypertension have an identifiable cause 16. Longterm high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral arterial disease, vision. Nov 11, 2012 internal medicine secondary hypertension 1. But, about 5 to 10% of cases of hypertension are due to secondary hypertension. Screening for specific forms of secondary hypertension is recommended. To diagnose secondary hypertension, your doctor will first take a blood pressure reading using an inflatable cuff, just as your blood pressure is measured during a typical doctors appointment. Systemic arterial hypertension is the most important modifiable risk factor for allcause morbidity and mortality worldwide and is associated with an increased risk of. Nov 18, 2009 with secondary hypertension, an underlying condition is causing the high blood pressure. Dermatological complains were promptly managed, a complete cardiovascular risk stratification was performed and.
In most of these cases renal dysfunction resulting from sever chronic kidney disease or renovascular disease is the most common secondary cause. Secondary hypertension or, less commonly, inessential hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. It has many different causes including endocrine diseases, kidney diseases, and tumors. Despite the 12 percentage point increase in prevalence with the lower diagnostic threshold, the 2017 accaha blood pres. The updated guideline also provides new treatment recommendations, which include lifestyle changes as well as bplowering medications, as shown in table 1. Context cardiovascular disease cvd risk increases beginning at systolic blood pressure levels of 115 mm hg. Diagnosing secondary hypertension american family physician. A view from a member of jnc 7 benefit either as 1 st or 2 ndline therapy ctd twice as potent as hctz ctd longer duration of action hctz 2550 mgd vs. Secondary hypertension can be caused by conditions that affect your kidneys, arteries, heart or endocrine system. Secondary hypertension symptoms and causes mayo clinic. The patients medical history was notable for noncontrolled hypertension and oslerweberrendu disease, while his current medication included lercanidipine 20 mg. Secondary hypertension is more common than primary hypertension in infants and young children. Nov, 2017 2017 hypertension clinical practice guidelines released. Links with this icon indicate that you are leaving the cdc website the centers for disease control and prevention cdc cannot attest to the accuracy of a nonfederal website.
On remand, the parties agreed that the board would address. Detection of secondary causes and coexisting diseases in. The secondary prevention of cardiovascular events in patients with hypertension and cad class iia. Secondary hypertension secondary high blood pressure is high blood pressure thats caused by another medical condition.