Secondary Hypertension

SECONDARY HYPERTENSION

Hypertension or High blood pressure one of the most important

contributers to cardiovascular sickness & death.

There is increased incidence of coronary, cerebrovascular and

renal arteriolar disease ( kidneys).

Most of the patients have primary or essential hypertension/

High blood pressure; they do not have an identifiable specific

cause for the rise in blood pressure.

About 5 percent of the persons with high blood pressure have

a specific cause which can be identified and most of them can

be treated successfully.

Identifying the patient with secondary hypertension/ High blood

pressure is important.

we must think of secondary hypertension/ High blood pressure,

when

a) The age is less than 30 years and onset is sudden.

b) Hypertension /High blood pressure is severe.

c) Systolic and diastolic murmurs can be heard in the abdomen.

d) There is history of passing blood in the urine.

e) The kidney can be palpated.

f ) Peripheral arterial pulses are absent or delayed

h ) There are indications of hormonal disorders.

What causes of secondary hypertension / High Blood pressure ?

There are many, one group is due to involvement of the kidney.

There can be reduced blood supply to the kidney ( narrowing of the

artery by stenosis or renal arterial disease). Other kidney disease

can also cause hypertension.

Glomerulonephritis is suggested by puffiness of face, scanty urine,

blood in urine and oedema.

Repeated episodes of fever with dysuria suggests pyelonephritis.

Both can lead to High blood pressure.

Another cause of hypertension is aldosteronism. Aldosterone is a

hormone produced by the adrenal gland. Excess of it leads to

high blood pressure.

Phaeochromocytoma, a tumour of the adrenal medulla, can be

another cause. It can cause dramatic episodes of high blood pressure.

The prevalence of hypertension is higher in diabetic patients.

steroids ( excess production in the body or given as treatment) can

cause high blood pressure. Skin ointments, eye drops and nasal sprays

contain steroids. They can lead to hypertension.

A case study : - Shyam, a 10 - year old boy with eczema ( a type of

skin disease), was treated for six years with an ointment containing

prednisolone. His arterial blood pressure was high. The average was

about 230/160mm Hg.

Hypertension was considered as essential and he was treated with

many anti - hypertensive drugs. after 6 years, a re- assement was

made after taking an accurate medical history. The correct diagnosis

was made and the steroids stopped. The blood pressure came down.

Many other drugs like phenylbutazone can cause hypertension, when

given large in large quantities.


Cigarette smoking can raise blood pressure.

The greater the quantity of alcohol ( more than 60 ml per day taken) the

higher the prevalence of hypertension.


Writer ................ Dr. G. Kuppuswamy FRCP FAMS

Summary by .. R.Krishna kumar