12
Diagnosis
Table 9. Causes of Secondary Hypertension With Clinical
Indications and Diagnostic Screening Tests
Prevalence Clinical Indications
Common causes
Renal parenchymal
disease
1%–2% Urinary tract infections; obstruction, hematuria;
urinary frequency and nocturia; analgesic abuse;
family history of polycystic kidney disease;
elevated serum creatinine; abnormal urinalysis
Renovascular disease
5%–34%
a
Resistant hypertension; hypertension of
abrupt onset or worsening or increasingly
difficult to control; flash pulmonary edema
(atherosclerotic); early-onset hypertension,
especially in women (fibromuscular hyperplasia)
Primary
aldosteronism
8%–20%
b
Resistant hypertension; hypertension with
hypokalemia (spontaneous or diuretic induced);
hypertension and muscle cramps or weakness;
hypertension and incidentally discovered adrenal
mass; hypertension and obstructive sleep apnea;
hypertension and family history of early-onset
hypertension or stroke
Obstructive sleep
apnea
c
25%–50% Resistant hypertension; snoring ; fitful sleep;
breathing pauses during sleep; daytime sleepiness
Drug or alcohol
induced
d
2%–4% Sodium-containing antacids; caffeine;
nicotine (smoking ); alcohol; NSAIDs; oral
contraceptives; cyclosporine or tacrolimus;
sympathomimetics (decongestants, anorectics);
cocaine, amphetamines and other illicit drugs;
neuropsychiatric agents; erythropoiesis-
stimulating agents; clonidine withdrawal; herbal
agents (Ma Huang, ephedra)
Uncommon causes
Pheochromocytoma/
paraganglioma
0.1%–0.6% Resistant hypertension; paroxysmal
hypertension or crisis superimposed on sustained
hypertension; "spells," BP lability, headache,
sweating, palpitations, pallor; positive family
history of pheochromocytoma/paraganglioma;
adrenal incidentaloma
Cushing's syndrome <0.1% Rapid weight gain, especially with central
distribution; proximal muscle weakness;
depression; hyperglycemia
