Hypertension Causes

Aka: Hypertension Causes, Secondary Hypertension Causes, Hypertension Causes in Children, Hypertension Causes in Adolescents

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II. Causes: Common Secondary Hypertension by age

  1. Age under 18 years
    1. See below
    2. Secondary cause in 10-15% of cases (70-85% of cases if under age 11 years old)
    3. Aortic Coarctation (esp. males)
    4. Renal parenchymal disease (most common in under age <12 years)
      1. Glomerulonephritis
      2. Vesicoureteral Reflux Nephropathy
      3. Conngenital abnormalities
  2. Age 19 to 39 years
    1. Secondary cause in 5% of cases
    2. Renal Artery Stenosis due to fibromuscular dysplasia
    3. Thyroid Disease
    4. Renal parenchymal disease
  3. Age 40 to 64 years
    1. Secondary cause in 8 to 12% of cases
    2. Hyperaldosteronism
    3. Thyroid Disease
    4. Obstructive Sleep Apnea
    5. Cushing Syndrome
    6. Pheochromocytoma
  4. Age over 65 years
    1. Secondary cause in 17% of cases
    2. Renal Artery Stenosis due to atherosclerotic disease
    3. Chronic Kidney Disease
    4. Thyroid Disease (Hypothyroidism, Hyperthyroidism)
  5. References
    1. Viera (2010) Am Fam Physician 82(12): 1471-8 [PubMed]

III. Causes: Secondary Hypertension in Adults

  1. See Resistant Hypertension
  2. See Severe Hypertension
  3. Endocrine Causes
    1. Primary Aldosteronism
      1. Most common treatable secondary cause of Hypertension
      2. Evaluate as cause in Refractory Hypertension where Hypokalemia (even borderline low Potassium)
    2. Pheochromocytoma (rare)
    3. Cushing's Disease
    4. Hyperparathyroidism
      1. Consider in Hypertension with Hypercalcemia
    5. Thyroid Disease
      1. Hyperthyroidism causes systolic Hypertension
      2. Hypothyroidism causes diastolic Hypertension
        1. Dernellis (2002) Am Heart J 143:718-24 [PubMed]
  4. Vascular Causes
    1. Aortic Coarctation
    2. Renal Artery Stenosis
  5. Medications or substances
    1. See Medication Causes of Hypertension
    2. Antihypertensive Withdrawal
    3. Alcohol Withdrawal
    4. Cocaine or other stimulant
    5. Serotonin Syndrome
    6. Anticholinergic Syndrome
    7. Malignant Hyperthermia
  6. Miscellaneous causes
    1. Obstructive Sleep Apnea
    2. Renal parenchymal disease
    3. Preeclampsia (Pregnancy Induced Hypertension)
    4. Cerebrovascular Accident

IV. Causes: Secondary Hypertension in age <18 years old

  1. See Hypertension in Infants
  2. Renal parenchymal disease (Most common cause in children under age 12 years - up to 70%)
    1. Glomerulonephritis
    2. Vesicoureteral Reflux Nephropathy
  3. Vascular Causes
    1. Renal Artery Stenosis (due to fibromuscular dysplasia)
    2. Aortic Coarctation
  4. Endocrine conditions
    1. Metabolic Syndrome
    2. Pheochromocytoma
    3. Hyperthyroidism
    4. Cushing Syndrome
    5. Congenital Adrenal Hyperplasia
  5. Essential Hypertension
    1. Less common in age <10 years (although accounts for growing percentage in this age group)
    2. Most common cause in adolescents and adults
  6. Miscellaneous Causes
    1. Obstructive Sleep Apnea
    2. Rheumatologic Disorder
  7. Medications
    1. See Medication Causes of Hypertension
    2. See Medication causes listed above under adult section

V. References

  1. Charles (2017) Am Fam Physician 96(7): 453-61 [PubMed]

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