Hypertensive Disorders

Primary Hypertension

Secondary hypertension

Primary Aldosterone

Cushing Syndrome

  • Presentation:
    • -HTN, buffalo hump, moon fancies, hirsutism, easy brusing

  • Path:

    • Glucocorticoids (cortisol) excess from adrenal gland due to overproduction of ACTH by pituitary adenoma -> unchecked activation of mineralocorticoid receptor

  • Diagnosis:

    • absence of cortisol suppression following dexamethasone administration

  • Treatment:

    • remove adenoma



  • Elevated TH stimulates sympathetic nervous system and HTN

Renovascular Hypertension

  • Features:
    • Most common cause of secondary hypertension, 10-15% of refractory hypertension
    • Unilateral or Bilateral
    • Episodic malignant hypertension
    • Flash pulmonary edema
    • Significant rise in creatinine when started on RAAS blocking in bilateral

  • Causes:
    • 1. Fibromuscular dysplasia
      • Non-atherosclerotic
      • A string of beads on Radiographic of renal artery
      • -congested/twisty renal artery
      • Commonly seen in young females
    • 2. Atherosclerosis
      • Most common cause of renovascular hypertension
      • Generally patients greater than 50 with known atherosclerosis
      • Typically occurs in the optimum or proximal portion of renal artery
      • -closer to the aorta

  • Unilateral vs. Bilateral:
    • Unilateral:
      • -constant elevation of renin/angiotensin/aldosterone out runs the normal kidney
      • compensation
      • -normal kidney keeps volume low
      • -secondary aldosterone
      • -treat with hormone blockers
    • Bilateral:
      • -high BP maintained by retention of salt and water
      • -treat with diuretics
      • -can have significant rise in creatinine with RAAS blocker

  • Diagnosis:
    • Blood test: elevated renin and aldosterone
    • Imaging: ultrasound, CT, MRI
    • Percutaneous catheter placement to measure Intravascular pressure

  • Treatment:
    • RAAS, CCB, Diuretics
    • Fibromuscular: balloon dilation
    • Atherosclerotic: only use balloon dilation with stents in extreme cases

Renal Parenchymal Hypertension

  • Presentation:
    • Renal Failure Hypertension
    • Elevated Na, increase in RAAS activity, overactivity of a sympathetic nervous system

  • Treatment:
    • -low Na diet
    • -diuretics
    • -RAAS blockers (ACE-I, Angio REceptor blockers)
    • -Beta-Blockers
    • -Dialysis

Sleep Apnea

  • HTN occurs due to activation of the sympathetic nervous system and RAAS
  • Suspect if snore, or ease, thick neck, or daytime sleepiness
  • Treat:
    • CPAP: continuous positive airway pressure

Coarctation of the aorta

  • Congenital narrowing of the aorta, on the downturn
  • Hypertension in upper limbs, with reduced BP in lower limbs
  • Delayer femoral pulses
  • Kids diagnosed with imaging, surgical treatment