Secondary Hypertension

Diagnosis

To diagnose secondary hypertension, a healthcare provider will take multiple blood pressure readings using an inflatable cuff. A single high reading is usually not enough for a diagnosis. Typically, 3 to 6 readings at separate appointments are needed, and home or ambulatory blood pressure monitoring may also be used.

Other tests to identify the cause of high blood pressure may include:

Blood tests

• Check levels of potassium, sodium, creatinine, blood glucose, total cholesterol, and triglycerides.

Urine test

• A urine sample can reveal markers of conditions that may cause high blood pressure.

Kidney ultrasound

• A noninvasive test using sound waves to create images of the kidneys to detect conditions linked to secondary hypertension.

Electrocardiogram (ECG or EKG)

• Records the heart’s electrical signals to determine whether heart problems may be contributing to high blood pressure. Sensors are attached to the chest and sometimes limbs, with results displayed as waveforms.

Treatment

Treatment for secondary hypertension focuses on addressing the underlying medical condition, which may involve medications or surgery. Blood pressure medication may also be required to maintain control.

Possible drug choices include:

Thiazide diuretics

• Help the kidneys eliminate sodium and water. Often the first choice in high blood pressure management.

• Side effects may include weakness, leg cramps, and sexual issues.

Beta blockers

• Reduce the heart’s workload and open blood vessels, slowing the heart rate.

• Side effects include fatigue, sleep problems, slowed heart rate, and cold extremities. Not recommended for people with asthma.

ACE inhibitors

• Relax blood vessels by blocking a natural chemical that narrows them.

• Side effects can include dizziness and coughing. Should not be used during pregnancy.

Angiotensin II receptor blockers

• Relax blood vessels by blocking the action of a natural chemical that narrows them.

• Fewer side effects than ACE inhibitors and should not be used during pregnancy.

Calcium channel blockers

• Relax the muscles of blood vessels or slow the heart rate.

• Side effects include water retention, dizziness, and constipation. Grapefruit juice may increase side effects.

Direct renin inhibitors

• Relax and widen arteries by preventing the action of renin. Example: aliskiren.

• Side effects can include dizziness and diarrhea. Not recommended for people with diabetes or significant kidney issues when combined with ACE inhibitors or ARBs.

Managing secondary hypertension may require multiple medications and lifestyle changes. Frequent monitoring, possibly monthly, and home blood pressure tracking can help ensure effective control.