During my GIM clinic, I saw a variety of patients in the longitudinal and rapid referral clinics.
After discussing with my team and reviewing the literature, I came away with the following general approach to secondary hypertension:
- Vascular
- Renal artery stenosis, fibromuscular dysplasia, coarctation of aorta
- Endocrine
- Cushing's
- Pheochromocytoma
- Hyperaldosteronism
- Hyper/hypothyroidism
- OSA
- Substance-induced
- Drugs: corticosteroids, OCPs, tacrolimus, cyclosporine, recreational (e.g. cocaine)
- Black licorice, caffeine, smoking, alcohol
In order to reduce unnecessary testing for secondary hypertension, it is important to do a thorough history and physical. For the history, a drug and substance use history can be quite significant. For the physical exam, I would like for features of the commonly associated endocrinopathies as well as auscultate for renal bruits.
-JT-
Reference(s):
https://guidelines.hypertension.ca/diagnosis-assessment/renovascular-hypertension/
https://guidelines.hypertension.ca/prevention-treatment/hypertension-endocrine-causes/
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