Secondary hypertension Renovascular hypertension

SECONDARY HYPERTENSION

Secondary hypertension is the name given to the hypertension of which the cause is known, and can be corrected in many cases to cure the hy­pertension.

Renal hypertension :

  • This is due to either renal se­retion of vasoactive compounds resulting in increased arteriolar tone or volume expansion due to distur­ance of sodium and fluid balance.
  • Uncontrolled hypertension comprises the following entities:
  • Secondary hypertension: Elevated blood pressure (BP) that results from an identifiable underlying mechanism Resistant hypertension: failure to achieve goal blood pressure (<140/90 mm Hg for the overall population and <130/80 mm Hg
  • for those with  chronic kidney disease or diabetes when a patient adheres to maximum tolerated doses of 3 antihypertensive drugs including a diuretic” Other causes: Inadequate treatment, poor patient adherence Poor control is most often due to persistent elevation in systolic BP

Secondary hypertension 1

Secondary hypertension Renovascular hypertension

Renal hypertension may be :

  • Renovascular hypertension including eclampsia and reeclamsia.
  • Renal parenchl’mal hypertension.
  • Renal vascular hypertension is due to stenosis of main or a branch of renal artery which activates the -renin angiotensin system (RAS).
  • The circulating angiotensin II causes vasoconstriction: LQ.v aldosterone secretion, sodium retention, stimulater: beren­glc nervous system a..!Jd al its direct action on:. e arterioles.
  • one half of the patients there is elevation of plasma
  • In activity RenaL.Parenchymal hypertension is due to in renal parenchymal disease with involvement of mulIe small renal vessels leading to decreased perfusion of renal tissue and bypertensiol
  • Peripheral plasma renin activity (PRA) is normal or increased
  • Cardiac output normal
  • Tilting and Valsalva maneuver have no effect
  • Blood volume is increased
  • Cardiac output increased
  • Tilting & Valsalva maneuver increase blood pressure
  • Blood volume is decreased in unilateral disease

Clinical Considerations

  • Pseudoresistance:
  • In primary care settings, this has been estimated to occur in 40–60% of hypertensive patients.
  • Poor adherence
  • White-coat effect: Prevalence estimated at 20–30%
  • Inaccurate measurement of BP:
  • Cuff too small
  • Patient not at rest; sitting quietly for 5 minutes
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