Definition and Overview

The heart’s main job is to ensure that the blood circulates properly throughout the body. This is how organs (such as the brain and the lungs) get their much-needed supply of oxygen and nutrients. The blood goes through the body’s many blood vessels. These tubular structures are flexible and are able to expand to allow blood to flow smoothly. Their expansion and contraction produce blood pressure. In healthy individuals, the normal blood pressure is about 120/80.

If the blood pressure goes up, it is referred to as hypertension. It can be either primary or secondary. It is secondary if caused by medical problems. These include disorders that affect the brain, kidneys, and heart. The most common are kidney disease and diabetes. It can also occur due to congenital heart problems and sleep apnea.

When left untreated, it can lead to several serious complications. These include heart failure, arterial damage, and vision problems.

Causes of Condition

Secondary hypertension can occur as a complication of:

  • Sleep apnea - A person with this disorder stops breathing for up to a couple of minutes while sleeping. This can be a cause for concern because it reduces the amount of oxygen in the body.

  • Narrowing of the heart’s main artery - When the aorta is narrowed, the amount of blood that passes through it is reduced. This forces the heart to pump harder to push more blood to other parts of the body. This can cause blood pressure to go up.

  • Diabetes - This refers to high blood sugar levels. It can cause damage to the blood vessels as well as the kidneys. Any damage to the blood vessels can affect normal blood pressure.

  • Adrenal gland disorders, which include abnormal growths and Cushing’s syndrome

  • Kidney disorders, which include kidney failure and polycystic kidney disease

  • Overactive parathyroid glands - A disorder that causes parathyroid glands to release more hormones than the body needs.

  • Thyroid problems - These can result in secondary hypertension if the thyroid glands produce more or less hormones than the body needs.

  • Preeclampsia

If left untreated, secondary hypertension can progress and increase the risk of blood clots. This can result in stroke, heart attack, and pulmonary embolism. These conditions can lead to death if not treated early.

Key Symptoms

A hypertension is secondary if:

  • The patient has any of the medical conditions listed above.

  • It does not respond to medications used to treat primary hypertension.

  • The patient does not have a family history of the disorder.

  • Occurs before the patient is 30 or is over 55.

Patients also display other symptoms caused by their primary medical problem. For example, they present with swollen feet and ankles if they are suffering from kidney failure. This happens because their kidneys can no longer filter excess water from blood.

Doctors choose tests and procedures to use based on the patient’s symptoms. If they are showing signs of a heart problem, for example, doctors will focus on assessing their heart’s function. This allows them to quickly diagnose the condition.

Who to See and Types of Treatments Available

Treatment of secondary hypertension focuses on treating its underlying cause. The patient undergoes a number of tests and procedures to determine what makes their blood pressure go up. These include:

  • Physical exam - This exam involves measuring the patient’s blood pressure. The doctor will also listen to the patient’s heartbeat using a stethoscope.

  • Review of the patient’s medical history and symptoms - The doctor would want to know if the patient has a family history of certain diseases. They would also ask about the severity of their symptoms and when they appeared first.

  • Blood and urine tests - These are used to measure the levels of hormones and other chemicals in the blood. They can be used if diabetes and disorders of the parathyroid and thyroid glands are suspected.

  • Echocardiogram - This test helps determine if the symptoms are caused by a problem with the heart’s artery. It produces pictures of the heart to help doctors easily spot any abnormality.

  • Sleep studies - These are used to see if the condition is caused by sleep apnea.

Patients diagnosed with secondary hypertension are prescribed with medications to help their kidneys work better. They are also given medications to improve blood flow to their arteries.

However, the definite cure for the condition is treating its underlying cause. This may involve dialysis for patients with kidney problems or controlling blood sugar levels for those with diabetes.

The symptoms of secondary hypertension can be improved with simple lifestyle changes. Thus, patients are advised to:

  • Eat a healthy diet. A diet rich in fruits and vegetables is best.

  • Exercise on a regular basis. Patients can benefit from exercising at least one hour per day. Doctors recommend a variety of exercises including yoga and weight training.

  • Minimise salt intake. This helps reduce water retention in the body.

  • Stop smoking. Smoking can cause damage to the blood vessels.

Avoid drinking alcohol as much as possible, as this also causes damage to the body’s various organs.

References:

  • The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm.

  • Gilbert SJ, et al. Secondary hypertension. In: National Kidney Foundation Primer on Kidney Diseases. 6th ed. Philadelphia, Pa.: Elsevier/Saunders; 2014. http://www.clinicalkey.com.

  • Overview of hypertension. Merck Manual Professional Version. http://www.merckmanuals.com/professional/cardiovascular-disorders/hypertension/overview-of-hypertension.

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