Secondary hypertension: what you need to know

Hypertension is a condition where blood pressure is raised. It can provoke serious health complications in the longer term, if not treated promptly. Highly experienced associate professor of renal medicine and consultant nephrologist Dr Rhys Evans discusses the basics of hypertension, its causes, symptoms, and available treatment options.

What is hypertension?

Hypertension is the medical term for high blood pressure, a common condition where the force of the blood against the artery walls is too high. For some patients with hypertension a specific underlying (‘secondary’) cause of hypertension is present, which should be identified to allow more specific treatment.  

What are the principal causes of secondary hypertension?

Secondary hypertension may be caused by:

• Any form of chronic kidney disease.
• Rare inherited diseases that affect how the kidney reabsorbs sodium.
• Diseases of the artery supplying the kidney (renal artery stenosis).
• Abnormal hormone production, especially from the adrenal glands (e.g. hyperaldosteronism).

Some of these conditions are difficult to diagnose, therefore it is helpful to consult a specialist, especially if hypertension develops at a young age (<40).

For most patients with hypertension, no secondary cause is identifiable. Other factors that can contribute to the development of hypertension include:

• Other medical conditions such as diabetes.
• Smoking.
• Ageing.
• Alcohol
• Some prescribed and over the counter medications.

What symptoms should I look out for?

Hypertension is usually not associated with symptoms unless it is very severe, which is why regular check-ups are crucial. Blood pressure should be checked if any of the following are present:

• Severe headache.
• Blurred vision.
• Shortness of breath.
• Chest pain
• Fatigue.

How is secondary hypertension diagnosed?

Diagnosis of secondary hypertension typically involves a combination of medical history review, physical examination, and specific tests. These tests may include:

• Blood and urine tests to check kidney function and hormone levels.
• Imaging tests such as ultrasound, CT scan, or MRI to view the arteries and kidneys.
• Specialist tests may include genetic analysis.

What treatment options are available?

Treatment for secondary hypertension is aimed at the underlying cause, alongside general measures for blood pressure control. These include:

Medications: Common blood pressure medications include ACE inhibitors, beta blockers, calcium channel blocker, and diuretics. These help manage blood pressure but do not address the underlying cause.

Lifestyle changes: Adopting a healthy lifestyle can significantly impact blood pressure. This includes a balanced diet low in salt, regular physical activity, maintaining a healthy weight, and quitting smoking.

Procedures targeting the cause: In certain cases, a procedure may be necessary. This may include an angioplasty, where a small balloon is used to widen a narrowed artery, or a procedure to remove part of an adrenal gland.

Living with hypertension

Managing hypertension is a lifelong commitment. Regular monitoring of blood pressure, adherence to prescribed medications, and lifestyle modifications are critical to prevent complications. Regular follow-ups with your healthcare provider are essential to ensure that the condition is well-managed and to make any necessary adjustments to your treatment plan.

Understanding and managing hypertension can significantly improve your quality of life and reduce the risk of severe complications. Always seek professional medical advice if you suspect you have symptoms of this condition.

If you are concerned about renal hypertension and would like to book a consultation with Dr Evans, do not hesitate to do so by visiting his Top Doctors profile today.