Primary and Secondary Causes of Hypertension - Differential Diagnosis Algorithm
Primary (Essential) (95%) - Onset between age 20 and 50. Positive family history. No features of secondary hypertension.
• Long-standing
• Uncontrolled
• Drug Withdrawal
Mislabelled - Repeatedly normal blood pressure when taken at home, work or when using an ambulatory monitor.
• White-coat Hypertension
• Masked Hypertension
Secondary Causes (5%) - Onset age < 20 or > 50 years, No family history. Hypertensive urgency. Resistant hypertension.
- Exogenous
• Corticosteroids
• Oral Contraceptive Pills
• Cocaine
• Black licorice
• Medications
- Renal
• Renal parenchymal disease - CKD, AKI, Glomerulonephritis
• Renovascular disease (unilateral and bilateral renal artery stenosis)
- Mechanical
• Aortic coarctation
• Obstructive Sleep Apnea
- Endocrine
• Glucocorticoid excess (Cushing syndrome or disease)
• Catecholamine excess (pheochromocytoma)
• Mineralocorticoid excess (primary aldosteronism)
• Hyperthyroidism (mainly systolic hypertension)
• Hypothyroidism (mainly diastolic hypertension)
• Hyperparathyroidism
• Pregnancy (Gestational hypertension)
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