Diagnostic modalities of the most common forms of secondary hypertension.

Abstract

nly 5-10% of hypertension cases are due to a definable cause. In general, a search for the cause of hypertension should be limited to patients with: a) new or sudden onset before the age of 20 or after the age of 50; b) mark-edly elevated blood pressure with severe end organ disease; c) resistant or refrac-tory hypertension; or d) specific biochemi-cal disturbances suggesting a secondary form of hypertension, and physical signs or a specific body habitus (central obesity, purple striae, abdominal bruits). There is a long list of diseases responsible for sec-ondary hypertension, some of them rare-ly encountered in clinical practice. Three causes of secondary hypertension that mer-it special attention are renovascular hyper-tension, mineralcorticoid excess states and catecholamine excess states. Targeted tes-ting and appropriate selection of diagnos -tic tests should allow prompt identifica-tion of patients with treatable causes of hypertension, avoidance of unnecessary ra-diation exposure, and cost minimization.