When to suspect a secondary form
Most cases of high blood pressure are hypertension, and there is no need to look for a rare cause in every patient. But there is a set of signs in which the probability of a secondary form is noticeably higher. First of all, this is resistance to treatment: the pressure remains high, despite three selected drugs in adequate doses, including a diuretic. Also alarming are the sudden onset, very high numbers, organ damage that does not correspond to the duration of the disease, and unusual accompanying symptoms.
- Onset of hypertension before 30 or after 60 years
- Blood pressure does not decrease on three medications
- Sudden deterioration in previously controlled blood pressure
- Very high numbers and crises
- Low blood potassium without obvious cause
- Attacks of palpitations, sweating and headaches
- Snoring with pauses in breathing and daytime sleepiness
Main reasons
Most often, secondary hypertension is caused by diseases of the kidneys and their vessels: chronic glomerulonephritis, polycystic disease, narrowing of the renal artery. The second large group is endocrine causes associated with excess adrenal hormones or dysfunction of the thyroid gland. Obstructive sleep apnea, which is very common and often goes unrecognized, deserves special attention. Finally, some drugs and substances increase blood pressure, and you should tell your doctor about this.
- Chronic kidney disease, polycystic disease
- Renal artery stenosis
- Primary hyperaldosteronism
- Pheochromocytoma and Cushing's syndrome
- Thyroid diseases
- Obstructive sleep apnea
- Combined oral contraceptives, glucocorticoids, painkillers, decongestants, licorice
Symptoms indicating the cause
Hypertension itself is often asymptomatic, but accompanying complaints sometimes directly indicate the direction of search. Attacks with sudden palpitations, sweating, paleness and a feeling of fear are characteristic of an adrenal tumor that produces stress hormones. Muscle weakness, cramps and frequent urination suggest excess aldosterone and low potassium. Weight gain with stretch marks, rounding of the face and fragility of blood vessels indicate an excess of cortisol. Night snoring with pauses in breathing and morning headaches are signs of sleep apnea.
- Palpitations with sweating and fear
- Muscle weakness and cramps
- Swelling, change in color and amount of urine
- Weight gain, stretch marks, round face
- Weight loss, shivering, heat intolerance
- Daytime sleepiness and morning headaches
Survey
They begin with confirmation of hypertension itself: home measurements according to the rules and daily blood pressure monitoring, which detects nighttime rises and assesses the real level. Basic examination includes blood and urine tests, assessment of kidney function, electrolytes, lipids and sugar, ECG and echocardiography. Then, as indicated, the doctor orders imaging of the kidneys and adrenal glands, hormonal studies, and a sleep study. It is important that some tests require stopping some medications in advance, so there is no point in taking them yourself.
- 24-hour blood pressure monitoring
- Urinalysis, creatinine, potassium and blood sodium
- Ultrasound of the kidneys and adrenal glands with Dopplerography
- Hormones: TSH, aldosterone, cortisol according to indications
- Echocardiography and fundus examination
- Sleep study for suspected apnea
- CT scan of the adrenal glands or renal vessels as prescribed by a doctor
Treatment
The main goal is to eliminate the cause. If the renal artery is narrowed, restoration of blood flow is discussed, with a hormonally active adrenal tumor - surgery, with sleep apnea - treatment with continuous positive airway pressure, and with drug-induced hypertension - drug replacement. At the same time, antihypertensive therapy is selected, because high blood pressure cannot be left uncontrolled even during the examination. Changing the regimen on your own and stopping the pills when you improve is dangerous: the pressure returns, but the risk of stroke remains.
- Treatment of the underlying disease
- Selection of antihypertensive drugs by a doctor
- Limiting salt, normalizing weight
- Sleep apnea treatment
- Stopping or replacing medications that increase blood pressure
- Regular home blood pressure monitoring with a diary
- Monitoring potassium and kidney function during therapy
