1. Genetic causes
- Hypertension can be caused by mutations in single genes.
- Liddle syndrome is an autosomal dominant condition characterized by early-onset hypertension, hypokalemic alkalosis, low renin and low aldosterone levels.
2. Renal disease
- Renal parenchymal disease is the most common cause of secondary hypertension.
- Mechanisms : related to increased intravascular volume or increased activity of the renin–angiotensin–aldosterone system.
3. Renal vascular hypertension
- Due to atherosclerotic stenoses of the renal arteries.
- Mechanisms : relate to excessive renin release due to reduction in renal perfusion pressure and attenuation of pressure natriuresis with stenosis affecting a single kidney or with bilateral renal artery stenosis.
- Renal vascular hypertension should be suspected in the following circumstances:
- (1) if the documented onset is before age 20 or after age 50 years.
- (2) hypertension is resistant to three or more drugs.
- (3) if there are epigastric or renal artery bruits.
- (4) if there is atherosclerotic disease of the aorta or peripheral arteries.
- (5) if there is an abrupt increase (> 25%) in the level of serum creatinine after administration of ACE inhibitors.
- (6) if episodes of pulmonary edema are associated with abrupt surges in blood pressure.
4. Primary hyperaldosteronism
- The lesion responsible for hyperaldosteronism is an adrenal adenoma or bilateral adrenal hyperplasia and can be demonstrated by CT or MRI scanning.
5. Cushing syndrome
- Excess glucocorticoid may induce salt and water retention through mineralocorticoid effects.
6. Pheochromocytoma
- The blood pressure elevation caused by the catecholamine excess results mainly from α-receptor-mediated vasoconstriction of arterioles, with a contribution from β1-receptor-mediated increases in cardiac output and renin release.
7. Coarctation of the aorta
8. Hypertension associated with pregnancy
- preeclampsia
- eclampsia
9. Estrogen use
- A small increase in blood pressure occurs in most women taking oral contraceptives, mostly in obese older than age 35 who have been treated for more than 5 years.
10. Other causes of secondary hypertension
- hypercalcemia
- acromegaly
- hyperthyroidism
- hypothyroidism
- baroreceptor denervation
- compression of the rostral ventrolateral medulla
- increased intracranial pressure
A number of medications may cause or exacerbate hypertension:
- cyclosporine
- tacrolimus
- angiogenesis inhibitors
- decongestants
- NSAID
Source: CMDT 2013