Adult secondary hypertension: What the primary care provider needs to know

Abstract

Although only a minority of patients with hypertension have secondary causes for it, identifying these patients is crucial, because treatment of the root cause may resolve or improve control of hypertension and improve long-term outcomes. Because primary care providers (PCPs) are the front line of screening for, diagnosis of, and management of hypertension, they have a vital responsibility to recognize clinical clues for secondary hypertension. Some of the important clues are treatment-resistant hypertension, onset of hypertension in a young adult, accelerated hypertension, and hypertension with unprovoked hypokalemia. Common causes of secondary hypertension are obstructive sleep apnea, renovascular disease, primary aldosteronism, renal parenchymal disease, and drugs. Some less-common causes include pheochromocytoma, Cushing syndrome, thyroid disease, hyperparathyroidism, and aortic coarctation. Each of these causes has suggestive symptoms and signs to prompt consideration and a diagnostic pathway.