title: Secondary hypertension in adults.
abstract: Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately.
authors.affiliation: Department of Endocrinology, Changi General Hospital, Singapore.
authors.forename: Troy Hai Kiat
authors.initials: TH
authors.lastname: Puar
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Yingjuan
authors.initials: Y
authors.lastname: Mok
authors.affiliation: Department of Renal Medicine, Changi General Hospital, Singapore.
authors.forename: Roy
authors.initials: R
authors.lastname: Debajyoti
authors.affiliation: Department of Endocrinology, Changi General Hospital, Singapore.
authors.forename: Joan
authors.initials: J
authors.lastname: Khoo
authors.affiliation: Care and Health Integration, Changi General Hospital, Singapore.
authors.forename: Choon How
authors.initials: CH
authors.lastname: How
authors.affiliation: Department of Renal Medicine, Changi General Hospital, Singapore.
authors.forename: Alvin Kok Heong
authors.initials: AK
authors.lastname: Ng
mesh_terms: D000450:Aldosterone / Q000097:blood*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis; D001794:Blood Pressure; D005921:Glomerulonephritis / Q000150:complications / Q000175:diagnosis; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis*; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation; D012078:Renal Artery Obstruction / Q000188:drug therapy; D012083:Renin / Q000097:blood*; D020181:Sleep Apnea, Obstructive / Q000150:complications
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000450:Aldosterone; D012083:Renin
keywords: obstructive sleep apnea; primary aldosteronism; renal artery stenosis; secondary hypertension