How to distinguish secondary hypertension

Arterial hypertension is characterized by an increase in pressure (above 140 to 90). Today, it is the most common chronic disease.

Distinguish between primary and secondary arterial hypertension. In the first case, the cause cannot be determined. Secondary arterial hypertension (symptomatic) is always associated with pathologies of organs involved in pressure regulation processes.

It develops for any reason, by identifying which, it is possible to bring the blood pressure back to normal and prevent the development of complications.

Primary and secondary arterial hypertension

Types of hypertension are distinguished as follows. Primary is called ordinary hypertension, which is detected in a quarter of the population. If the patient complains only of high blood pressure, as a rule, we are talking about this form of pathology.

Secondary (symptomatic) arterial hypertension appears due to any disease, most often the kidneys, the endocrine system. Such pathologies negatively affect other organs. Before choosing a treatment, the doctor directs efforts to find and eliminate the cause of hypertension.

Another main difference is the high blood pressure – above 180-200, and under the influence of antihypertensive drugs, the pressure decreases slightly. Secondary hypertension can also be suspected in case of development of changes in target organs (heart, kidneys, brain).

Secondary nephropathy with arterial hypertension often leads to wrinkling (downsizing) of the kidneys. In advanced cases, they stop working, then a life-threatening condition develops.


Secondary arterial hypertension accompanies more than 50 diseases. There is a classification of hypertension (depending on the cause of development). 5 secondary forms of arterial hypertension are conventionally distinguished:

The cause of the neurogenic form of hypertension is vascular disease, damage to the peripheral and central nervous system (stroke, brain tumors). The hemodynamic form is caused by damage to the myocardium, major vessels: heart disease (acquired, congenital), aortic pathology, valves. The dosage form of hypertension develops after taking certain drugs: glucocorticoids, antidepressants, contraceptives, etc.

Hyperparathyroid hypertension is caused by increased secretion of parathyroid hormone, which regulates calcium levels. The endocrine form of the disease also develops due to a tumor of the adrenal gland, other organs, when the level of corticosteroids rises. The reason for the increase in blood pressure are tumors:

  • Aldosterone (high levels of aldosterone);
  • Pheochromocytoma (high levels of adrenaline norepinephrine).

Symptomatic hypertension that develops due to kidney damage is often detected. There are nephrogenic forms of hypertension: parenchymal and renovascular. In the first case, a persistent increase in pressure accompanies nephropathy, polycystosis, pyelonephritis, glomerulonephritis, and tuberculosis of the kidneys.

Such diseases are characterized by a violation of the structure of organ tissues. Renovascular (vasorenal) hypertension appears if the blood flow is difficult (usually with sclerotic vascular disease).

It is accompanied by the following clinical manifestations:

  • Headache;
  • Frequent heartbeat;
  • Dizziness;
  • Weakness;
  • Noise in ears;
  • Swelling of the face, limbs;
  • “Flies” before the eyes;
  • Nausea;
  • Irritability;
  • Anxiety.
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High blood pressure is sometimes the only manifestation of secondary hypertension. Additionally, symptoms of the underlying disease appear. Neurogenic hypertension is accompanied by a change in heart rate, sweating, pain in the head.

The endocrine form can be manifested in fullness, while the volumes of the limbs do not change, and only the face and body grow fuller. Symptoms of renal hypertension are severity, headache, visual impairment, increased heart rate. At the initial stage, the disease may not manifest in any way, except for malaise.


Other required studies:

  • Analysis for sugar, cholesterol, creatinine;
  • Determination of the level of sodium, potassium;
  • Test according to Nechiporenko, Zimnitsky;
  • ECG;
  • Fundus studies.

The differential diagnosis algorithm for secondary hypertension includes 2 stages. First, the doctor analyzes the anamnesis, symptoms, course of the disease.

The basis for the diagnosis of secondary arterial hypertension at stage 1 is the data of studies, a survey, and a patient examination.

There are several signs that help distinguish a disease from primary hypertension:

  • Age younger than 20 years. and over 60 l.;
  • The sudden appearance of hypertension with high blood pressure;
  • Fast current;
  • Sympathoadrenal crises;
  • The presence of etiological diseases;
  • Ineffectiveness of antihypertensive drugs.

In the presence of symptoms characteristic of secondary hypertension, the second stage of diagnosis begins. It includes methods that assess the presence / absence of violations in the structure and functions of organs. In some cases, a standard examination does not show deviations. Then an additional ultrasound, X-ray, CT, MRI.

When identifying a disease due to which the pressure is increased, the diagnosis of secondary arterial hypertension is made. Timely determination of the cause allows you to choose adequate therapy. According to the International Classification of Diseases of the ICD 10, secondary arterial hypertension has the code I15.

The goal of treating secondary hypertension is to address the root cause. With a hemodynamic renal patient, drug therapy is prescribed. If the treatment is effective, the pressure returns to normal.

If tumors or vascular pathologies are detected, surgical intervention is necessary. Indications and type of operation are determined taking into account the age of the patient, the nature and severity of concomitant diseases. If sclerotic processes, inflammation in the kidneys are detected, symptomatic therapy is selected. Prevention of the development of renal failure is necessary.

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For all forms of hypertension, drugs that lower blood pressure are prescribed: diuretics, ACE inhibitors, sartans, beta-blockers, calcium antagonists.


Prevention of arterial hypertension is a priority for people with a hereditary addiction, and for those who have blood pressure kept within the extreme norm. This will prevent the development of the disease or its complications.

Prevention of hypertension can be primary and secondary. Primary includes methods that will help to avoid the development of the disease. These include:

  • Stress prevention;
  • Normalization of the central nervous system;
  • Compliance with the daily routine;
  • Sleep for at least 8 hours;
  • Physical activity, including and in the air (walking, cycling, etc.).
  • Refusal of cigarettes;
  • Refusal or restriction of alcohol consumption (no more than 30 ml per day);
  • Reducing the daily amount of salt (up to 6 g).

If there is obesity, it is important to reduce weight. This should be done gradually, losing no more than 3-4 kg per month.

Measures to prevent hypertension include a balanced diet. You can not allow excess fat in the diet (more than 50-60 g per day). Animal fats should be no more than 1/3 of the indicated norm.

Fast carbohydrates should be limited: sugar, sweets, flour. A sufficient amount of proteins (low-fat fish, poultry, sour-milk products, etc.) should be included in the diet. It is good to eat foods containing a lot of calcium, magnesium, potassium:

Non-drug therapy corresponds to the primary prevention measures indicated above. It is necessary to regularly monitor the pressure, measuring it at least twice a day. You should follow the doctor’s recommendations and seek medical attention in case of a worsening condition.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.