EDWARD ONUSKO, M.D., Clinton Memorial Hospital, Wilmington, Ohio
Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause.Only about 5 to 10 percent of hypertension cases are thought to result from secondary causes.The ABCDE mnemonic can be used to help determine a secondary cause of hypertension: Accuracy of diagnosis, obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, excess Erythropoietin, and Endocrine disorders.An algorithm showing the general strategy to help screen for factors involved in secondary hypertension is presented.Routine urinalysis, complete blood cell count, blood chemistry profile (potassium, sodium, creatinine, fasting glucose, fasting lipid levels), and a 12-lead electrocardiogram are recommended for all patients with hypertension. (Am Fam Physician 2003;67:67-74.Copyright© 2003 American Academy of Family Physicians)
...EDWARD ONUSKO, M.D., is associate director of the family practice residency program at Clinton Memorial Hospital, Wilmington, Ohio.He also is associate professor of clinical family medicine at the University of Cincinnati College of Medicine.He graduated from Case Western Reserve University School of Medicine in Cleveland, Ohio, and completed a residency in family medicine at University Hospitals of Cleveland. Address correspondence to Edward Onusko, M.D., Clinton Memorial Hospital, 825 W. Locust St., Wilmington, OH 45177 (e-mail: firstname.lastname@example.org).
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O'Rorke JE, Richardson WS.Evidence based management of hypertension: what to do when blood pressure is difficult to control.