UMEM Educational Pearls

Category: Vascular

Title: Secondary Hypertension...Say What?

Keywords: Hypertension (PubMed Search)

Posted: 4/19/2010 by Rob Rogers, MD (Updated: 12/9/2019)
Click here to contact Rob Rogers, MD

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:

  • Obstructive sleep apnea
  • Renal disease
  • Renal artery stenosis (think older person with HTN and abdominal bruit)
  • Coarctation (young person with HTN-ever wonder why pediatricians palpate upper and lower extremity pulses in the office?)
  • Cushing's disease (excess cortisol-patient may have new diabetes, have abdominal striae, and easy bruising)
  • Hyperaldosteronism (due to an adrenal tumor)...think about if a patient comes to the ED and is repeatedly hypokalemic and hypertensive
  • Pheochromocytoma (episodes of flushing, hypertension, palpitations, etc.)
  • Hypothyroidism (not myxedema coma or storm)...commonly causes elevated diastolic BP. 
  • Hyperthyroidism 

Consider the ABCDE mnemonic:

A-Accuracy (is it really htn?), Apnea, Aldosteronism

B-Bruits, Bad Kidneys

C-Catecholamines, Coarctation, Cushing's 

D-Drugs, Diet

E-Endocrine

 

Aren't you glad you didn't do a Medicine residency???

References

Onusko E. Diagnosing secondary hypertension. Am Fam Physician. 2003 Jan 1;67(1):67-74.