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Secondary Hypertension

What is secondary hypertension?

High blood pressure occurs when blood pushes too hard against the walls of your arteries while traveling through the body.

This extra pressure — called hypertension — can damage your organs over time. It can damage your heart, brain, eyes, lungs, and kidneys.

Doctors use the term secondary hypertension to refers to high blood pressure that is caused by some other underlying disease. Your doctor may suspect secondary hypertension if your high blood pressure is not controlled with treatments that are usually effective, you suddenly develop high blood pressure, if the blood pressure is severely elevated, or if you develop hypertension at a young age. 

Definitions of secondary hypertension

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

Causes of secondary hypertension

Secondary hypertension can have many different causes. Major causes include:

  • Some medications can cause secondary hypertension.
  • Chronic kidney disease (including diabetic kidney disease).
  • Genetic kidney diseases.
  • Narrowing of blood vessels (affecting the blood supply to the kidney).
  • Endocrine disorders (e.g. elevated levels of hormones such as aldosterone, thyroid hormone, cortisol, or adrenaline).
  • Obstructive sleep apnea.

Complications of secondary hypertension

High blood pressure can cause a number of complications related to damage to blood vessels over time. These can include damage to the heart, the brain, or the kidneys. It can be deadly if left untreated.

How to manage secondary hypertension

The good news related to secondary hypertension is that if doctors can identify a specific cause of the high blood pressure, this can indicate an effective way to treat the blood pressure.  

Your doctor will help you control your secondary high blood pressure by:

  • Treating the underlying disease. For example, by correcting imbalances in electrolytes, improving blood supply to the kidneys, treating hormonal abnormalities that cause high blood pressure, or treating sleep apnea. 
  • Recommending specific changes to diet and lifestyle. 
  • Prescribing specific medications tailored to the cause of the high blood pressure.

Why choose UPMC for renal hypertension care?

At the UPMC Kidney Disease Center, our experts:

  • Specialize in care for secondary and difficult-to-treat hypertension.
  • Treat the full spectrum of kidney diseases, including diabetic kidney disease, chronic kidney disease, inherited kidney disease, and glomerular disease.
  • Partner with experts in endocrinology, cardiology, genetics and nutrition to provide comprehensive care.

At the UPMC Kidney Disease Center, we will work with you to identify the cause of your high blood pressure and help you manage your high blood pressure to slow the progression of kidney disease.

Secondary Hypertension Symptoms and Diagnosis

Some doctors call high blood pressure a “silent killer" because most people do not feel different when their blood pressure is higher. 

Diagnosing secondary hypertension

If your primary care doctor suspects you may have secondary hypertension, they will refer you to a nephrologist.

What a nephrologist can do is perform a specialized investigation into the potential causes of your hypertension. This investigation includes:

  • Asking you to regularly monitor your blood pressure at home.
  • Blood and urine tests to assess your kidney function, electrolyte balance, and hormone levels.
  • Imaging of your heart and blood vessels.
  • In rare cases, genetic testing may be indicated.

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

Secondary Hypertension Treatment

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.
  • Surgery to improve blood flow to the kidneys.

Lifestyle treatments for renal hypertension

Your doctor will suggest lifelong heart-healthy lifestyle changes to help control your hypertensive kidney disease like:

  • Eat a healthy diet. Along with eating more fruits, veggies, and lean protein, it's vital to limit your salt intake.
  • Increase your activity level. Find a sport or other physical activity you enjoy. Commit to being active for 30 to 60 minutes most days of the week.
  • 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.
  • Don't smoke, and limit your intake of alcohol. Both smoking and drinking raise blood pressure. Your doctor will let you know if moderate drinking is safe for you.

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

You'll also need to check your blood pressure often. Your doctor will let you know how and when to check it at home.

Medicine to treat secondary hypertension

Most people who have the disease also need to take one or more drugs to control their high blood pressure:

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

Surgical treatments for high blood pressure

In patients with decreased blood flow to the kidneys, your nephrologist may refer you to an interventionalist to perform one of the following procedures:

  • Renal artery stenting. In this non-surgical 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.  This 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 so that it improves blood flow to the kidney.

Contact the UPMC Kidney Disease Center

To learn more about kidney disease: