Keywords: Hypertension (PubMed Search)
Secondary Hypertension...say what?
We obviously see tons of patients in the ED with hypertension, and we are very comfortable with both symptomatic and asymptomatic presentations. Most of these patients have essential or primary hypertension. Some patients, however, may have secondary hypertension (i.e. something is causing it). Although we will refer patients to a primary care physician for further management and workup it is worth discussing when to suspect other diagnoses as the cause of the hypertension. Is it out job necessarily to diagnose these conditions in the ED? No.
Causes of secondary hypertension to consider:
Consider the ABCDE mnemonic:
A-Accuracy (is it really htn?), Apnea, Aldosteronism
B-Bruits, Bad Kidneys
C-Catecholamines, Coarctation, Cushing's
Aren't you glad you didn't do a Medicine residency???
Onusko E. Diagnosing secondary hypertension. Am Fam Physician. 2003 Jan 1;67(1):67-74.