Secondary Hypertension (Renal Hypertension)

High blood pressure happens when your blood pushes too hard against the walls of your arteries while traveling through your body. This extra pressure — called hypertension — can damage your heart, brain, eyes, lungs, and kidneys over time.

Doctors use the term secondary hypertension to refer to high blood pressure caused by an underlying disease, such as a kidney or endocrine condition. When secondary hypertension is caused by kidney disease, it is sometimes called renal hypertension.

The experts at UPMC specialize in treating secondary hypertension. Our team will find the cause of your condition and develop a treatment plan to manage your symptoms and reduce your risk of complications.

On this page

• What Is Secondary Hypertension?
• What Are the Symptoms of Secondary Hypertension?
• How Do You Diagnose Secondary Hypertension?
• How Do You Treat Secondary Hypertension?

What Is Secondary Hypertension?

Doctors use the term secondary hypertension to refer to high blood pressure caused by an underlying disease, such as a kidney or endocrine condition. When secondary hypertension is caused by kidney disease, it is sometimes called renal hypertension.

Your doctor may suspect secondary hypertension if you have high blood pressure that:

• Happens suddenly.
• Is not controlled with treatments that are usually effective.
• Is severely elevated.
• Occurs at a young age. 

What are the types of secondary hypertension? 

There are different types of secondary hypertension, including:

• Renal hypertension or hypertensive renal disease — Happens when your high blood pressure is caused by an underlying kidney disease.
• Resistant hypertension — Happens when your blood pressure continues to be high, even when you are taking three or more medications to help control it.

What causes secondary hypertension?

Secondary hypertension can have different causes, including:

• Chronic kidney disease, including diabetic kidney disease.
• Endocrine disorders, such as elevated levels of hormones such as aldosterone, thyroid, cortisol, or adrenaline.
• Genetic kidney disease.
• Medications.
• Narrowing of blood vessels that affects the blood supply to your kidneys.
• Obstructive sleep apnea.

What is the cause of renal hypertension?

Renal hypertension is a type of secondary hypertension that is caused by kidney disease.

What is the most common cause of secondary hypertension?

The most common cause of secondary hypertension is kidney disease. Hormone disorders and obstructive sleep apnea are other common causes.

What are secondary hypertension risk factors and complications? 

Secondary hypertension risk factors

You may be at higher risk for secondary hypertension if you have conditions including:

• Diabetes.
• Diseases that affect your blood vessels.
• Hormone disorders.
• Kidney disease.
• Obstructive sleep apnea.
• Pregnancy.

Complications of secondary hypertension 

High blood pressure can damage blood vessels over time, leading to complications that affect your heart, brain, and kidneys. If left untreated, high blood pressure can be life-threatening. 

How can I prevent secondary hypertension? 

You may be able to prevent secondary hypertension by maintaining a healthy weight and treating any health conditions that can increase your risk for the disease. If you can’t prevent your secondary hypertension, taking care of your overall health can help you manage your condition.

To reduce your risk of secondary hypertension, you can:

• Control chronic conditions — See a doctor for regular care if you have diabetes or obstructive sleep apnea.
• Eat healthy — Eat a healthy diet with lots of fruits and vegetables. They're high in potassium, which promotes healthy blood pressure. Limiting salt from shakers and processed foods also helps reduce your blood pressure.
• Exercise — Aim for at least 30 minutes of moderate-intensity physical activity most days of the week.
• Get preventive care — Check your blood pressure and blood sugar (glucose) routinely.
• Keep track of medications — Inform your doctor if you routinely take over-the-counter drugs or herbal supplements and avoid or limit the use of NSAID medications (e.g., ibuprofen, naproxen).
• Manage stress — Take steps to manage stress and get at least 7 to 8 hours of sleep each night.
• Reduce alcohol intake — Limit alcohol to one drink a day for women and two drinks per day for men.
• Stop smoking — Quit smoking if you smoke cigarettes or marijuana.

How common is secondary hypertension?

Although high blood pressure is a common condition, especially among older people, secondary hypertension only affects about 10% of people diagnosed with high blood pressure. However, secondary hypertension is more common in younger people with high blood pressure.

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What Are the Signs and Symptoms of Secondary Hypertension?

Most people with high blood pressure don’t notice any symptoms.

Severe high blood pressure can cause:

• Chest pain.
• Confusion.
• Nausea and vomiting.
• Nosebleeds.
• Severe headache.
• Shortness of breath.
• Vision changes.

Does secondary hypertension go away?

In some cases, secondary hypertension may go away if the underlying cause is successfully treated. Some types of secondary hypertension may not go away but may be managed with ongoing treatment.

When should I see a doctor about my secondary hypertension symptoms?

If you experience severe symptoms of high blood pressure, call 911 or go to the nearest hospital emergency department.

If a medical provider tells you that your blood pressure is high or you notice an increase in your blood pressure during a home test, you should schedule an appointment with your primary care provider.

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How Do You Diagnose Secondary Hypertension?

If your primary care doctor suspects you may have secondary hypertension caused by a kidney condition, they will refer you to a nephrologist — also known as a kidney doctor. Your nephrologist will perform a physical exam, talk to you about your health history, and order blood and urine tests that can help to diagnose secondary hypertension.

What to expect during your visit

Your nephrologist will try to find the cause of your high blood pressure by:

• Asking you to regularly monitor your blood pressure at home.
• Ordering blood and urine tests to assess your kidney function, electrolyte balance, and hormone levels.
• Ordering imaging of your heart and blood vessels.
• Referring you for genetic counseling and testing in rare cases.

Tests to diagnose secondary hypertension

Your doctor may order tests to find the cause of your high blood pressure, including:

• Anion gap blood test — Checks your body’s acid-base balance and looks for electrolyte imbalances.
• Electrolyte panel — Checks levels of electrolytes in your blood.
• Hormone tests — Checks levels of hormones in your blood
• Urine electrolyte test — Checks levels of electrolytes in your urine.

Your doctor may also order a test called an estimated glomerular filtration rate (eGFR), which shows how efficiently your kidneys are functioning based on your age, creatinine level, and sex.

Secondary hypertension prognosis

Your secondary hypertension prognosis depends on the cause and severity of your condition, as well as your overall health. Your doctor will discuss your prognosis with you.

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How Do You Treat Secondary Hypertension?

At UPMC, we’ll work with you to identify the cause of your high blood pressure and help you manage end-organ damage from secondary hypertension.

By identifying the cause of your hypertension, your nephrologist can work with you to develop a personalized plan to treat your condition and get your blood pressure under control.

Goals of secondary hypertension treatment include:

• Managing your blood pressure.
• Preventing organ damage.
• Reducing your risk of heart attack, stroke, and other complications.

If you have secondary hypertension caused by kidney disease, your doctor will design a treatment plan that may include:

• Lifestyle changes to manage your disease.
• Medicine to control your high blood pressure.
• Medicine to treat your underlying kidney disease.
• Minimally invasive procedures to treat overactive nerves that control blood pressure.
• Other interventions.

Lifestyle changes for renal hypertension

Your doctor will suggest lifelong lifestyle changes to help control your hypertensive kidney disease, including:

• Lose weight if needed — If you're not overweight, be sure to stay at a healthy weight. If you're overweight or obese, ask your doctor how to reduce your BMI.
• Eat healthy — Eat a healthy diet with lots of fruits and vegetables. They're high in potassium, which promotes healthy blood pressure. Limiting salt from shakers and processed foods also helps reduce your blood pressure.
• Exercise — Aim for at least 30 minutes of moderate-intensity physical activity most days of the week.
• Get preventive care — Routinely check your blood pressure and blood glucose (sugar).
• Reduce alcohol intake — Limit alcohol to one drink a day for women and two drinks per day for men.
• Stop smoking — Quit smoking if you smoke cigarettes or marijuana.

Your doctor can refer you to a UPMC nutritionist or weight-loss specialist if you need help.

Medicine to treat secondary hypertension

Most people who have secondary hypertension also need to take one or more drugs to control their high blood pressure.

What medication is used for renal hypertension?

Medications may include:

• Diuretics — Also known as water pills, these help your body get rid of excess sodium and water.
• ACE inhibitors — These help relax blood vessels so blood can pass through them more easily.
• Angiotensin II receptor blockers (ARBs) — These block natural chemicals that narrow blood vessels and help them to relax.
• Calcium channel blockers — These help relax the muscles in your blood vessels and may also slow your heart rate.
• Mineralocorticoid antagonists — These block the action of aldosterone.

Minimally invasive procedures for secondary hypertension

A new, FDA-approved procedure called renal denervation is a minimally invasive treatment option for people with secondary hypertension that doesn’t respond to medication or lifestyle changes.

Renal denervation works by destroying overactive nerves near the renal (kidney) arteries that control blood pressure. When these nerves become overactive, they send signals to the brain that tell the body to raise blood pressure. Destroying the nerves and “disconnecting” them from the brain can help lower blood pressure.

What happens during renal denervation?

During renal denervation, your doctor will:

• Give you local or general anesthesia to keep you comfortable during your procedure.
• Make a small incision in your upper leg.
• Insert a small, thin tube called a catheter through the incision into your blood vessel.
• Use x-ray imaging to guide the catheter to your renal (kidney) arteries.
• Use ultrasound or radiofrequency energy to damage overactive nerves around your renal arteries, “disconnecting” them from your brain and preventing them from sending signals to your brain to raise blood pressure.
• Remove the catheter and close your incision.

How long does it take to recover from renal denervation?

Renal denervation is typically an outpatient procedure, so you should be able to return home the same day. Most people can resume normal activities within a few days.

How successful is renal denervation?

Renal denervation is a highly successful procedure for secondary hypertension. Most people see a drop in their blood pressure numbers and can reduce their blood pressure medications. Some people may be able to stop taking blood pressure medications completely.

Other interventions for secondary hypertension

In patients with decreased blood flow to the kidneys, your nephrologist may refer you to another medical specialist, such as an interventionalist, vascular surgeon, or urologist, to perform procedures to improve blood flow to the kidneys.

Procedures include:

• Renal artery stenting — In this nonsurgical procedure, a physician inserts a catheter into the artery to the kidney and inflates a balloon, sometimes with a wire stent to prop the artery open. The stent improves blood flow to the kidney.
• Renal artery bypass — Surgeons first harvest a blood vessel from elsewhere in your body. They then graft the vessel into place to improve blood flow to the kidney.

Why choose UPMC for secondary hypertension care?

When you choose UPMC for secondary hypertension care, you will receive:

• Access to world-class nephrology expertise — Our world-renowned experts use the latest diagnostic and treatment techniques and specialize in caring for people with secondary and difficult-to-treat hypertension.
• A full range of treatment options — We offer the most advanced therapies to treat the full spectrum of kidney diseases, including diabetic kidney disease, chronic kidney disease, inherited kidney disease, and glomerular disease.
• Multidisciplinary care — We partner with experts in endocrinology, cardiology, genetics, and nutrition to provide comprehensive care.

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By UPMC Editorial Staff. Last reviewed on 2025-04-24 by William Hoffman, MD.