The Diagnosis and Treatment of Secondary Hypertension
Compared to Primary hypertension, Secondary hypertension is less common and is caused by a number of factors. However, it is important to know the differences between the two and knows which treatment to choose. In this article, you will learn more about the diagnosis of Secondary Hypertension, as well as the treatment options available for this condition.
Primary hypertension vs secondary hypertension
Often called the “silent killer,” hypertension is a condition that is difficult to control and can lead to serious complications. However, a number of people can be cured of high blood pressure when it is properly diagnosed and treated.
Primary hypertension is a type of hypertension that results from an underlying medical condition. It is the most common form of hypertension among adolescents. Secondary hypertension is a different form of hypertension that can occur in a variety of different medical conditions. Typically, it is caused by an endocrine disease or disorder.
The most common cause of secondary hypertension is an abnormality in the kidney artery. Other causes include renal artery stenosis, thyroid disorders, and diseases of the adrenal glands. There are a variety of other causes, including drug use, pregnancy, and airway obstruction during sleep.
The main treatment for secondary hypertension is to treat the underlying cause. This may require medication or surgery. The goal is to bring the patient’s blood pressure within a safe range. Some patients may need to continue taking high blood pressure medications after they are diagnosed with secondary hypertension.
Although the risk factors for secondary hypertension are the same as those for primary hypertension, the symptoms are different. They come on suddenly and are associated with an electrolyte imbalance. It is important to discuss any side effects of medications with a doctor.
Several different medications are used to treat secondary hypertension. Those used most commonly include ACE-DIU and b-blockers. ACE inhibitors/ARBs were also used. The most frequent combinations of medications were prescribed by primary care physicians (PCPs) and subspecialists.
Despite its widespread presence, there is little evidence to support specific treatment thresholds for pharmacological intervention. There is a need for more studies to determine the effect of treatment patterns on blood pressure control.
The use of echocardiograms and EKGs in the diagnosis of hypertension were similar between primary and secondary hypertension. Compared to primary hypertension, the use of echocardiograms was higher in adolescents, particularly those between the ages of 15 and 17. It was also more likely for subjects to get an echocardiogram when they were between the ages of 12 and 14.
Whether or not a person has primary or secondary hypertension depends on the cause. The risk factors for primary hypertension include ethnicity, family history, and exercise habits.
Diagnosis of secondary hypertension
Identifying secondary hypertension is important for treatment. There are a number of factors that should be evaluated for primary and secondary hypertension, including age, family history, and medications.
A metabolic panel can identify many causes of secondary hypertension. The blood tests can include measuring total cholesterol, potassium, sodium, and creatinine. This is an inexpensive initial lab work-up. Depending on the etiology, additional imaging may be necessary.
In addition to evaluating for primary and secondary hypertension, providers should evaluate patients for hard-to-control hypertension. These may include drug-related hypertension, as well as hypertension associated with illicit substances.
Inpatient providers are particularly suited to evaluating and treating patients with secondary hypertension. They have the benefit of real-time feedback on medication response. They can also identify those at high risk of secondary hypertension and determine whether or not the patient needs an additional work-up.
The most common cause of secondary hypertension is a renal parenchymal disease. This condition damages the functional part of the kidney. In addition to assessing kidney function, doctors should evaluate the urine for drug intoxication. A 24-hour urine drug screen is useful for this diagnosis.
An electrocardiogram is another diagnostic test. The technician attaches electrodes to the chest and records the electrical signals on a monitor. The technician then connects the electrodes to a computer. The results of the electrocardiogram can help diagnose the etiology of the underlying condition.
In some cases, secondary hypertension is associated with obstructive sleep apnea. In these cases, an evaluation for obstructive sleep apnea should be performed. A sleep study can also be used to detect obstructive sleep apnea and other causes of hypertension.
In some cases, secondary hypertension can be diagnosed by determining the aldosterone/renin ratio. This ratio is a good indicator of whether a patient is experiencing secondary hypertension or not. In addition to detecting disease, this measurement can help confirm the diagnosis of aortic coarctation.
Inpatient evaluation is also a good way to identify patients who are at high risk for secondary hypertension. This includes patients who are younger than 30 and who have significant hypokalemia.
Treatment of secondary hypertension
Identifying the cause of secondary hypertension is crucial for treating the condition. This will prevent long-term medical therapy and reduce the risk of serious complications.
In some cases, the underlying condition may be treated with medications. In others, a surgical procedure may be required. Other treatments include changes in lifestyle. Some patients require home blood pressure monitoring.
If there is a risk of secondary hypertension, then the patient should be screened for it. This is a laborious, expensive, and time-consuming process.
General clinical clues to identify secondary hypertension include elevated blood pressure, increased sweating, fatigue, muscle weakness, palpitations, and headache. Chest pain, shortness of breath, and blurred vision are other symptoms.
Screening for secondary hypertension is important in young adults who do not have any risk factors. If the patient is overweight, the health team should also perform a metabolic syndrome screening. This is a cluster of metabolic disorders that can increase the risk of heart disease, stroke, and diabetes.
When screening for secondary hypertension, the provider should be aware of the historical clues to its occurrence. For example, people who have had a ruptured aneurysm or aortic coarctation are at high risk of developing hypertension.
Symptoms of secondary hypertension include hyperaldosteronism, hydrocortisone, and hypokalemia. These conditions may lead to complications such as weight gain, osteoporosis, and glucose intolerance.
Treatment of secondary hypertension involves changing a person’s diet and lifestyle. These changes may include eating a diet rich in vegetables, low-fat dairy foods, and potassium. These foods can help decrease the risk of cardiovascular disease and diabetes.
For suspected cases of secondary hypertension, plasma aldosterone concentration should be measured. Acute kidney injury should be considered if the creatinine is higher than normal. The diagnosis of CKD can be clarified by a urinalysis.
The main objective of this book is to present the most important considerations regarding the management of secondary hypertension. The textbook covers vascular, renal parenchymal, neurogenic, and metabolic disorder-related hypertension. It also discusses psychosocial, hereditary, and drug-related hypertension.
The book is divided into parts I and part II. In part I, the reader is introduced to the basics of hypertension, the most common causes of hypertension, and the medical, psychological, and social aspects of this condition. The second part of the book deals with secondary hypertension of different types.
Treatment of renovascular hypertension
Despite the widespread use of surgical interventions for the treatment of renovascular hypertension, few studies have evaluated the long-term outcomes of such surgery in children. The purpose of this study was to investigate whether changes in the operative treatment of pediatric renovascular hypertension over the past 30 years were associated with good long-term salutary responses.
The most common type of revascularization in patients with pediatric renovascular hypertension is angioplasty. In most cases, the procedure is effective and has a relatively low restenosis rate. However, this is not true for all children. Thromboses and intimal disruptions may lead to persistent hypertension. In some cases, a nephrectomy may be needed. Alternatively, aortic reconstruction can improve blood pressure control.
In the pediatric population, stenoses in renal arteries are complex. They are usually found coexisting with abdominal aortic coarctations. They are also often accompanied by neurofibromatosis type 1 or Williams syndrome.
The most common types of renal artery lesions in children are non-stretch and inflammatory mural fibrosis. In addition, there is usually bilateral disease, which affects the entire mass of the renal parenchyma. In some instances, asymmetric renal size is found during imaging tests.
The most effective drugs for the treatment of renovascular hypertension are angiotensin-converting enzyme inhibitors and angiotensin receptor-1 blockers. Angiotensin receptor-1 blockers are generally avoided because of rare complications.
The underlying etiology of renovascular hypertension is not clearly understood. This lack of clarity leads to a lack of evidence-based recommendations for the treatment of the disease. Moreover, the data on the etiology of the renovascular disease is not as available as those for other diseases, and there is little information on the etiology of the disease in children.
Nonetheless, there are indications that evidence of renin suppression is important for assessing pediatric renovascular hypertension. In the present study, a significant proportion of patients with renal artery stenoses had evidence of renin hypersecretion. This may be helpful in identifying patients with renovascular hypertension who require intervention.
In conclusion, the revascularization technique used for the treatment of pediatric renovascular hypertension must be individualized. This is important for avoiding complications and enhancing long-term success.
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Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
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