14
Diagnosis
Hypothyroidism <1% Dry skin; cold intolerance; constipation;
hoarseness; weight gain
Hyperthyroidism <1% Warm, moist skin; heat intolerance;
nervousness; tremulousness; insomnia; weight
loss; diarrhea; proximal muscle weakness
Aortic coarctation
(undiagnosed or
repaired)
0.1% Young patient with hypertension (<30 y of age)
Primary
hyperparathyroidism
Rare Hypercalcemia
Congenital adrenal
hyperplasia
Rare Hypertension and hypokalemia; virilization
(11-beta-hydroxylase deficiency [11-beta-
OH]); incomplete masculinization in males
and primary amenorrhea in females (17-alpha-
hydroxylase deficiency [17-alpha-OH])
Mineralocorticoid
excess syndromes
other than primary
aldosteronism
Rare Early-onset hypertension; resistant
hypertension; hypokalemia or hyperkalemia
Acromegaly Rare Acral features, enlarging shoe, glove, or hat size;
headache, visual disturbances; diabetes mellitus
a
Depending on the clinical situation (hypertension alone, 5%; hypertension starting dialysis,
22%; hypertension and peripheral vascular disease, 28%; hypertension in the elderly with
congestive heart failure, 34%).
b
8% in general population with hypertension; up to 20% in patients with resistant
hypertension.
c
Although obstructive sleep apnea is listed as a cause of secondary hypertension, RCTs on the
effects of continuous positive airway pressure on lowering BP in patients with hypertension
have produced mixed results (see Obstructive Sleep Apnea for details).
d
For a list of frequently used drugs causing hypertension and accompanying evidence,
see Table 10.
Table 9. Causes of Secondary Hypertension With Clinical
Indications and Diagnostic Screening Tests (cont'd)
Prevalence Clinical Indications
