Secondary Hypertension

High blood pressure, sometimes called hypertension, can have different causes. One type, called secondary hypertension, is caused by another health problem. This "other" problem might involve the kidneys, blood vessels (arteries), the heart, or the body's hormone-producing system (endocrine system). Pregnancy can also sometimes lead to secondary hypertension.

Secondary hypertension is different from the more common type of high blood pressure, often just called "high blood pressure" or primary hypertension. In primary hypertension, the cause isn't clearly linked to another medical condition.

Treating secondary hypertension effectively often means addressing both the high blood pressure and the underlying medical problem. This comprehensive approach can help control the high blood pressure and the original health issue. Proper treatment significantly lowers the chances of serious problems like heart disease, kidney failure, and stroke.

High blood pressure, often called hypertension, can sometimes be a sign of an underlying problem, rather than just a general health issue. This is called secondary hypertension. Similar to regular high blood pressure (primary hypertension), secondary hypertension often doesn't have noticeable symptoms, even when blood pressure becomes dangerously high.

However, there are some clues that your high blood pressure might be secondary. If you have high blood pressure, pay attention to these potential warning signs:

• Your blood pressure medication isn't working: If your blood pressure remains high despite taking medication, this could indicate secondary hypertension. This is sometimes called resistant hypertension.
• Extremely high blood pressure: A reading of more than 180/120 millimeters of mercury (mm Hg) is very high. This, along with other factors, could suggest a secondary cause. (Systolic pressure is the top number and diastolic pressure is the bottom number).
• Blood pressure medication that used to work stops working: If a medication that previously controlled your blood pressure is no longer effective, it could be a sign of a changing underlying cause.
• Sudden high blood pressure: A rapid increase in blood pressure, especially before age 30 or after age 55, could be a sign of a secondary cause. This is different from gradual increases that occur over time.
• No family history of high blood pressure: If no one in your family has a history of high blood pressure, it might suggest a different cause for your condition.
• Not overweight or obese: While obesity can be a factor in high blood pressure, if you are not overweight or obese and still have high blood pressure, this could be a sign of secondary hypertension.

It's crucial to remember that these are just potential indicators. If you have any of these signs, it's essential to talk to your doctor. They can perform the necessary tests to determine the exact cause of your high blood pressure and recommend the best course of treatment.

If you have a health condition that can lead to high blood pressure (also called secondary hypertension), it's important to monitor your blood pressure more closely. Talk to your doctor or other healthcare provider about how often you should have your blood pressure checked. They can recommend a specific schedule based on your individual situation.

High blood pressure, sometimes called hypertension, can have various underlying causes. Not all high blood pressure is the same. Sometimes, it's a symptom of another medical condition, called secondary hypertension. This means that another problem is causing the high blood pressure. Understanding these underlying causes is crucial for effective treatment.

Kidney Issues and Secondary Hypertension

Many kidney diseases can lead to high blood pressure. The kidneys are vital for filtering waste and excess fluid from the body. When they don't function properly, blood pressure can rise. Here are some examples:

• Diabetes Complications (Diabetic Nephropathy): Diabetes can damage the delicate filtering system in the kidneys. This damage makes it hard for the kidneys to do their job, leading to high blood pressure.

• Polycystic Kidney Disease: This genetic condition causes fluid-filled sacs (cysts) to grow in the kidneys. These cysts interfere with the kidneys' normal function, potentially increasing blood pressure.

• Glomerular Disease: The kidneys have tiny filters called glomeruli that remove waste and sodium. In glomerular disease, these filters become swollen and damaged. This can disrupt the kidneys' ability to regulate blood pressure.

• Renovascular Hypertension: This happens when the arteries leading to the kidneys narrow. This narrowing, called stenosis, forces the heart to work harder to pump blood, resulting in higher blood pressure. This narrowing can be caused by fatty deposits (atherosclerosis, similar to what can affect the heart's arteries) or by abnormal thickening of the artery walls (fibromuscular dysplasia).

Hormonal Imbalances and Secondary Hypertension

Problems with hormones can also cause secondary hypertension. Hormones are chemical messengers that control many bodily functions. If the balance is disrupted, blood pressure can be affected:

• Cushing Syndrome: Corticosteroids, medications used for various conditions, can sometimes cause high blood pressure. This condition can also be due to a pituitary tumor or other issues that make the adrenal glands produce too much cortisol, a hormone affecting metabolism and stress response.

• Aldosteronism: The adrenal glands produce aldosterone, a hormone that helps the body regulate sodium and potassium levels. Too much aldosterone leads the body to retain sodium and water, and lose potassium. This imbalance raises blood pressure.

• Pheochromocytoma: This is a rare tumor, often found in the adrenal glands. It produces excessive amounts of adrenaline and noradrenaline, hormones that control the body's response to stress. This can cause dramatic, sudden spikes in blood pressure.

• Thyroid Problems: An underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) can impact blood pressure.

• Hyperparathyroidism: The parathyroid glands control calcium and phosphorus levels. If they produce too much parathyroid hormone, blood calcium levels increase, leading to high blood pressure.

Other Causes of Secondary Hypertension

Several other conditions can contribute to secondary hypertension:

• Coarctation of the Aorta: This is a birth defect where the main artery (aorta) is narrowed. This forces the heart to work harder to circulate blood, especially to the arms, causing higher blood pressure there.

• Sleep Apnea: This condition, often characterized by loud snoring, involves pauses in breathing during sleep. The lack of oxygen can damage blood vessel linings, making it difficult for the vessels to control blood pressure. Sleep apnea also triggers the nervous system to release chemicals that increase blood pressure.

• Obesity: Increased body weight leads to more blood circulating through the body. This puts extra pressure on the artery walls, raising blood pressure. Obesity also increases heart rate and makes it harder for blood vessels to move blood efficiently. Fat tissue itself can release chemicals that elevate blood pressure.

• Pregnancy: Pregnancy can sometimes cause or worsen pre-existing high blood pressure, often called pregnancy-induced hypertension or preeclampsia.

• Medications and Supplements: Some prescription medications (painkillers, birth control pills, etc.) and supplements (ginseng, licorice, ephedra) can increase blood pressure in some individuals. Many illegal drugs, like cocaine and methamphetamine, also raise blood pressure significantly.

It's important to remember that this is not an exhaustive list. If you have high blood pressure, it's essential to consult a doctor to determine the underlying cause and receive appropriate treatment.

High blood pressure that develops after other health problems (called secondary hypertension) is most often caused by underlying medical issues. These problems can affect the kidneys, arteries, heart, or the body's hormone-producing system (endocrine system). For example, if your kidneys aren't working properly, they might cause high blood pressure. Similarly, issues with your arteries, heart, or endocrine glands can also lead to high blood pressure. Essentially, problems in these areas can disrupt the body's normal blood pressure regulation, resulting in higher-than-normal readings.

High blood pressure (hypertension) that's not caused by a primary condition (like a problem with the kidneys) can make existing health issues worse. If left untreated, this type of high blood pressure can lead to serious problems, including:

• Damaged arteries: High blood pressure can damage the inner lining of your arteries, causing them to harden and narrow (atherosclerosis). This can restrict blood flow, making you more prone to heart attacks, strokes, and other complications.

• Aneurysms: High blood pressure can weaken the walls of blood vessels, causing them to bulge out (aneurysm). If an aneurysm bursts, it can be life-threatening.

• Heart problems: Your heart has to work harder to pump blood against the higher pressure. Over time, this can cause your heart muscle to thicken. A thickened heart muscle might not be able to pump enough blood, leading to heart failure.

• Kidney problems: High blood pressure can damage the tiny blood vessels in the kidneys. This can reduce the kidneys' ability to filter waste and fluids from the blood, potentially leading to kidney disease.

• Vision problems: High blood pressure can damage the blood vessels in the eyes, potentially leading to vision loss or other eye problems.

• Metabolic syndrome: High blood pressure is often part of a group of conditions called metabolic syndrome. This cluster of issues includes increased belly fat, high levels of unhealthy fats (triglycerides), low levels of good cholesterol (HDL), and high blood sugar. Having high blood pressure along with other metabolic syndrome components increases your risk of diabetes, heart disease, and stroke.

• Cognitive problems: Uncontrolled high blood pressure can affect your brain. This can make it harder to think clearly, remember things, and understand information. It is more likely to occur in people with high blood pressure.

If you have high blood pressure, it's important to talk to your doctor. They can help you manage it and prevent these potential complications. The more components of metabolic syndrome you have, the greater your risk of developing serious health problems. Managing your blood pressure is a crucial step in protecting your overall health.

Diagnosing high blood pressure that's not caused by lifestyle factors (called secondary hypertension) involves several steps.

First, a healthcare professional will use a blood pressure cuff to measure your blood pressure. Having high blood pressure once doesn't automatically mean you have secondary hypertension. Doctors often need to take several blood pressure readings over a few visits. Sometimes, they'll use home blood pressure monitors or ambulatory blood pressure monitors. These devices track your blood pressure throughout the day, providing more complete information.

To figure out why your blood pressure is high, the doctor may order other tests:

• Electrocardiogram (ECG or EKG): This is a simple, painless test that records the electrical activity of your heart. Sensors (small sticky pads called electrodes) are placed on your chest (and sometimes your arms or legs). The test shows how your heart is beating and can help identify any heart problems that might be contributing to high blood pressure.

• Blood tests: These tests check the levels of different substances in your blood, such as potassium, sodium, creatinine, blood sugar (glucose), and cholesterol and triglycerides. These levels can reveal underlying health conditions that are affecting your blood pressure.

• Urine test (urinalysis): A urine sample can contain substances that indicate certain medical problems that can lead to high blood pressure.

• Kidney ultrasound: Some kidney conditions can cause high blood pressure. During an ultrasound, a technician uses a small, hand-held device (a transducer) to send sound waves into your body. The sound waves bounce back, and a computer uses this information to create images of your kidneys, allowing doctors to check for any problems.

• Electrocardiogram (ECG or EKG): (This section is repeated; it should be removed as it's a duplicate of the earlier ECG/EKG explanation.)

By combining these blood pressure readings and test results, doctors can better understand the cause of your high blood pressure and develop an appropriate treatment plan.

Treating High Blood Pressure When It's Not Just High: Secondary Hypertension

Secondary hypertension means your high blood pressure is a symptom of another underlying health problem. Treating this type of high blood pressure involves addressing the root cause. This might involve medication or surgery for the underlying condition. Often, once the underlying problem is treated, your blood pressure will improve or return to normal.

However, even after the underlying issue is resolved, you might still need to take blood pressure medication. The best medication choice depends on your specific situation, including the underlying health condition.

Here are some common types of blood pressure medications used to treat secondary hypertension:

1. Thiazide Diuretics (Water Pills):

These are often the first type of blood pressure medication doctors prescribe, but not always. They work by helping your kidneys get rid of extra sodium and water, which reduces the amount of fluid in your blood vessels, lowering blood pressure.

Thiazide diuretics are frequently available as generic medications, making them more affordable than some other types of blood pressure pills. If your blood pressure is still high despite not taking a diuretic, talk to your doctor about adding one or swapping out a medication for a diuretic. Possible side effects include weakness, leg cramps, and sometimes, problems with sexual function.

2. Beta Blockers:

These medications slow your heart rate and relax your blood vessels, reducing the strain on your heart. While they can be effective, they aren't as helpful for Black individuals when used alone. They often work better when combined with a thiazide diuretic.

Side effects can include tiredness, trouble sleeping, a slow heartbeat, and cold hands and feet. People with asthma should usually avoid beta blockers, as they can worsen asthma symptoms.

3. ACE Inhibitors:

ACE inhibitors help relax blood vessels by blocking a natural chemical that narrows them. They're often a good choice for people with conditions like coronary artery disease, heart failure, or kidney disease. Like beta blockers, ACE inhibitors are less effective for Black people when used alone, but they can be quite helpful in combination with a diuretic.

Side effects can include dizziness and a persistent cough. ACE inhibitors are not safe to take during pregnancy.

4. Angiotensin II Receptor Blockers (ARBs):

ARBs also relax blood vessels by blocking a different natural chemical than ACE inhibitors. They are also commonly used for people with coronary artery disease, heart failure, or kidney disease. Often, ARBs have fewer side effects than ACE inhibitors. ARBs are also not recommended during pregnancy.

5. Calcium Channel Blockers:

These medications relax the muscles in your blood vessels or slow your heart rate. They might be a better option for some people compared to ACE inhibitors or beta blockers alone.

Possible side effects include water retention, dizziness, and constipation. Important note: Grapefruit juice can interact with some calcium channel blockers, increasing their blood levels and potentially causing more side effects. Always check with your doctor or pharmacist about any potential interactions with your medications.

6. Direct Renin Inhibitors:

These medications work by preventing the action of an enzyme called renin, which helps narrow blood vessels. An example of this type of medication is aliskiren (Tekturna).

Common side effects include dizziness and diarrhea. People with diabetes or significant kidney problems should not combine direct renin inhibitors with ACE inhibitors or ARBs.

Managing Secondary Hypertension:

Treating secondary hypertension can sometimes require a combination of medications and lifestyle changes. Your doctor may need to see you more frequently—perhaps monthly—to monitor your blood pressure until it's well-controlled. Tracking your blood pressure at home can also be helpful. A comprehensive approach to managing your blood pressure is essential for your overall health.

Maintaining a healthy heart and low blood pressure involves making some simple lifestyle changes. These changes can significantly improve your overall health and well-being.

Managing Your Sodium Intake:

Reducing the amount of salt in your diet is crucial. For people 51 and older, and for people of any age who are Black, have high blood pressure (hypertension), diabetes, or chronic kidney disease, aiming for 1,500 milligrams (mg) of sodium a day is best. Otherwise healthy adults should try to consume 2,300 milligrams (mg) or less daily. This means being mindful of the salt shaker and paying close attention to the sodium content in packaged foods like canned soups and frozen meals. Reading food labels can help you track your sodium intake.

Nourishing Your Body with Healthy Foods:

Eating a balanced diet is essential. The Dietary Approaches to Stop Hypertension (DASH) diet is a great example. It focuses on fruits, vegetables, whole grains, and low-fat dairy. Including potassium-rich foods like potatoes, spinach, bananas, and apricots can help control high blood pressure. It's also important to limit saturated and total fat intake.

Maintaining a Healthy Weight:

Losing even a moderate amount of weight can significantly lower blood pressure. If you're overweight, losing 10 pounds (4.5 kilograms) can make a difference.

Staying Active:

Regular physical activity is vital for heart health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This could include brisk walking, swimming, cycling, or any activity that gets your heart pumping.

Moderating Alcohol Consumption:

Alcohol can raise blood pressure, even for healthy people. If you choose to drink alcohol, do so in moderation. For healthy adults, this means up to one drink a day for women and two drinks a day for men.

Quitting Smoking:

Smoking damages blood vessel walls and accelerates the process of hardening of the arteries (atherosclerosis), which is a major risk factor for heart disease. If you smoke, talk to your doctor about quitting. There are many resources and support groups available to help you quit.

Managing Stress:

Stress can affect your blood pressure. Practice healthy stress-management techniques, such as relaxation exercises (like deep breathing or progressive muscle relaxation) and getting enough sleep. Finding healthy ways to cope with stress can significantly improve your overall health and well-being.