Secondary hypertension is high blood pressure with an identifiable and sometimes treatable cause. Studies have suggested that secondary hypertension may be present in 10% of individuals with hypertension and up to 30% of those with resistant hypertension. Despite its significant prevalence, many providers do not consider secondary causes when diagnosing hypertension, as obesity and essential hypertension, which affects up to 50% of U.S. adults, are so common that other etiologies are overlooked. To further explore the issue, researchers performed a cross-sectional study involving 2090 hypertensive adults aged 18 to 40 who underwent comprehensive evaluations for secondary causes. Secondary hypertension was identified in 29.6% of participants (N=619), with the most frequent etiologies being:

• Primary aldosteronism (54.8%)
• Primary kidney disease (12.9%)
• Drugs or substances (6%)
• Pheochromocytoma/functional paraganglioma (5.9%)
• Other (2.7%)

Factors associated with a higher prevalence of secondary causes included female sex, hypokalemia, treatment with at least two medications, no family history of hypertension, BMI less than 25, and diabetes.

This study was eye-opening, as I rarely consider secondary hypertension in adult patients. So many people are overweight and/or out of shape, it is easy to fall into the trap of attributing most conditions to these issues. After seeing these results, I will be more inclined to consider secondary causes, particularly in patients with factors associated with greater risk.

• AHA recommendations on whom to evaluate for secondary hypertension
• Causes of secondary hypertension