title: [Hypertension: once primary, always primary?].
abstract: Three patients diagnosed with primary hypertension suddenly developed hard-to-treat blood pressure after several years of stable blood pressure. One patient, a man aged 48 years, had developed a renal artery stenosis, which had not been present five years earlier. The other two patients, a man aged 57 years and a woman aged 27 years, were diagnosed with an aldosterone-producing adenoma of the left adrenal gland and a pheochromocytoma, respectively. In patients with previously stable blood pressure, sudden derangement may be due to secondary hypertension on top of the pre-existing primary hypertension. A thorough history and physical examination together with limited laboratory investigations usually leads the way to the correct diagnosis.
authors.affiliation: Universitair Medisch Centrum St Radboud, afd. Algemeen Interne Geneeskunde, Postbus 9101, 6500 HB Nijmegen.
authors.forename: R L
authors.initials: RL
authors.lastname: Braam
authors.forename: G F F M
authors.initials: GF
authors.lastname: Pieters
authors.forename: Th
authors.initials: T
authors.lastname: Thien
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism; D018246:Adrenocortical Adenoma / Q000150:complications / Q000378:metabolism; D000328:Adult; D000450:Aldosterone / Q000378:metabolism; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications; D012078:Renal Artery Obstruction / Q000150:complications
chemical_list: D000450:Aldosterone