Hypertension: Secondary Hypertension

Hypertension is classified as "essential (primary)" or "secondary” hypertension. Essential hypertension does not have an apparent cause. It may be due to such things as genetics (family members who have the disease) or lifestyle. Nearly all cases of hypertension fall into the essential category.

Secondary hypertension, on the other hand, is less common and is the result of another condition or disorder, such as:

• Disorders of the adrenal gland (small organs, located above the kidneys, that create hormones), including Cushing's syndrome (a condition caused by an overproduction of cortisol); hyperaldosteronism (too much aldosterone); and pheochromocytoma (a rare tumor that causes oversecretion of hormones like adrenaline)
• Kidney disease which may include polycystic kidney disease, kidney tumor, kidney failure, or a narrow or blocked main artery supplying the kidney
• Drugs such as corticosteroids (anti-inflammatory drugs like prednisone), nonsteroidal anti-inflammatory drugs (Motrin or Aleve or Naprosyn), Cox-2 inhibitors (Bextra and Vioxx, which were both recently removed from the market, and Celebrex), weight loss drugs (such as Meridia and Ephedra – a supplement recently banned by the FDA), cold medications that include pseudoephedrine (like Sudafed), birth control pills (the estrogen component), and migraine medications (such as Imitrex)
  Editor's note: Vioxx was removed from the market in September 2004 due to concerns that it increases the risk of heart attack and stroke. On April 7, 2005 Pfizer -- the maker of Bextra and Celebrex – agreed to an FDA request to suspend the sale of Bextra. The FDA said the risks of the drug outweighed the benefits. On the same day the FDA asked Pfizer to add a warning to the label of Celebrex that highlights the risk of heart attack, stroke, and the potential for life-threatening stomach bleeding. Learn more about the FDA actions on Bextra and Celebrex.
• Sleep apnea, a condition in which a person has brief spells in which he stops breathing during sleep. About half of patients with this condition have hypertension.
• Coarctation of the aorta, a birth defect in which the aorta is narrowed
• Preeclampsia- a condition related to pregnancy
• Thyroid and parathyroid problems

How Is Secondary Hypertension Diagnosed?

After you are diagnosed with hypertension, your doctor may perform other tests such as blood and urine screening to see if you have secondary hypertension.

Would also include a section on who should be evaluated for Secondary HTN. i.e. severe HTN resistant to treatment, a sudden rise in blood pressure over a previously stable level, young age of onset of hypertension etc…

How Is Secondary Hypertension Treated?

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.) and try to correct that.

In some cases, this may mean that you will have to undergo surgery; for example, if you have a kidney disorder. Not all patients will be eligible for surgery, however. Your doctor may also choose to treat you with antihypertensive drug therapy, whether or not you have surgery.

If you have secondary hypertension that is caused by a drug, your doctor may suggest that you stop taking that drug.

Reviewed by the doctors at The Cleveland Clinic Heart Center.