Secondary hypertension

Patients with secondary hypertension may complain of symptoms suggestive of the underlying disorder. Patients with pheochromocytoma may have a history of paroxysmal headaches, sweating, tachycardia, palpitations, and orthostatic hypotension. In primary aldosteronism, hypokalemic symptoms of muscle cramps and weakness may be present. Patients with hypertension secondary to Cushing s syndrome may complain of weight gain, polyuria, edema, menstrual irregularities, recurrent acne, or muscular weakness. 

In situations of known renin-angiotensin-aldosterone involvement, such as in hypertension secondary to renal disease (i.e., renovascular hypertension), diuretics probably should not be used because they further elevate plasma renin. 

Unlabeled Uses Treatment of CHF, hypertension secondary to eclampsia and pre-eclampsia, primary pulmonary hypertension. 

Glucocorticoid creams applied topically to the skin are routinely used in the treatment of many skin disorders, and their use on the face in severe atopic eczema is relatively common. Three patients developed advanced glaucoma while using topical facial glucocorticoids. Two other patients developed ocular hypertension secondary to topical facial glucocorticoids (430). 

Bond DW, Charlton CP, Gregson RM. Benign intracranial hypertension secondary to nasal fluticasone propionate. BMJ 2001 322(7291) 897. 

The authors identified hypertension secondary to the use of cocaine as the risk factor for this complication. 

Portal hypertension secondary to arterioportai fistulae two unusual cases. Liver 1999 19 343-347... 

Packer M, Medina N, Yushak M. Adverse hemodynamic and clinical effects of calcium channel blockade in pulmonary hypertension secondary to obliterative pulmonary vascular disease. J Am Coll Cardiol 1984 4(5) 890-901. 

Secondary Pulmonary Hypertension. Secondary pulmonary hypertension is seen in some heart transplant candidates, and documenting the potential for reversibility when the primary defect is corrected is important in selecting appropriate heart transplant candidates and liver transplant patients as well. Aerosolized prostacyclin has been shown at least as effective as inhaled NO 40 ppm for this purpose in heart transplant candidates [170], while aerosolized epoprostenol has been shown similarly useful in liver transplant candidates. Delivery of iloprost was faster with an ultrasonic nebulizer but equally efficacious as compared to a jet nebulizer [171]. The role of aerosolized prostacyclin and related medications for pulmonary hypertension and for diagnostic evaluation of transplant candidates remains to be proven. Certainly, a successful aerosol treatment for pulmonary hypertension would be well received because of the inconvenience of the current method of constant infusion via an indwelling catheter. From an economic viewpoint, the market is small, so the chance of recovery of investment in new treatment would be limited. 

Hypertension is a heterogeneous medical condition. In most patients it results from unknown pathophysiologic etiology (essential or primary hypertension). While this form of hypertension cannot be cured, it can be controlled. A small percentage of patients have a specific cause of their hypertension (secondary hypertension). There are many potential secondary causes that are either concurrent medical conditions or are endogenously induced. If the cause of secondary hypertension can be identified, hypertension in these patients potentially can be cured. 

Detry-Morel M, Escarmelle A, Hermans I. Refractory ocular hypertension secondary to intravitreal injection of triamcinolone acetonide. Bull Soc Beige Ophthalmol 2004 292 45-51. 

Secondary hypertension. Secondary hypertension affects 10% of patients who are hypertensive and is caused by secondary disorders of the renal and endocrine systems. 

Interventional treatment of children with portal hypertension secondary to portal vein occlusion. Eur J Pediatr Surg 13 312-218... 

Spangler ML, Saxena S. Warfarin and bosentan interaction in a patient with pulmonary hypertension secondary to bilateral pulmonary emboh. Clin Ther 2010 32(1) 53-6. 

The survey of cases of gout with renal involvement in relation to blood pressure (Table IV) revealed, in the hypertensive secondary renal gout, an earlier age of onset a higher incidence of females a predominance of the acute clinical type and a higher incidence of gouty attacks caused by the admin Istration of diuretic drugs. On the contrary. In the normotensive group, uric acid renal lithiasis and diabetes were more frequent, which confirms the non-specificity of these parameters. 

Swartbol et al. (10) studied 450 consecutive patients with peripheral vascular disease to evaluate risk factors associated with renal artery stenosis. Of 221 patients who had peripheral arterial disease and a renal artery lesion detected by angiography, 44 were normotensive and 177 were hypertensive. The authors concluded that hypertension secondary to renal artery stenosis was significantly correlated with peripheral vascular disease. They also noted an association with age over 70 years, smoking history, and an abnormal baseline ECG. 

A 44-year-old Hispanic woman with pulmonary hypertension secondary to scleroderma, but no previous allergic disorders, had a generalized maculopapular rashafter taking bosentan for 18 days. Her symptoms subsided with oral betamethasone for 10 days and 1 month later she underwent skin tests, patch tests, lymphocyte transformation tests (all of which were also performed in three controls who had scleroderma and who had tolerated bosentan), and a controlled oral provocation test. The skin and patch tests were negative... 

Olschewski H, Ghofrani HA, Walmrath D, et al. Inhaled prostacyclin and iloprost in severe pulmonary hypertension secondary to lung fibrosis. Am J Respir Crit Care Med 1999 160(2) 600-607. 

Thompson JS, Sheedy W, Morice AH. Neutral endopeptidase (NEP) inhibition in rats with established pulmonary hypertension secondary to chronic hypoxia. Br J Pharmacol 1994 113 1121-1126. 

A57-year-old man taking VPA 1000 mg/day developed hyperammonemic encephalopathy and subsequent coma. He had portal hypertension secondary to history of alcohol abuse and was found to have a portosystemic shxmt, which had previously gone xiimoticed. While asymptomatic hyperammonemia is a relatively common side effect of VPA, encephalopathy and coma are less common. The portosystemic shunt may have prevented metabolism of ammonia in this case [185 ]. Regardless, VPA should be used with caution in a patient with a history of alcohol abuse given the increased risk for liver disease. 

The pulmonary involvement in more common in men. Pulmonary manifestations include interstitial fibrosis, pleuropulmonary nodules (single or clusters), pneumonitis and arteritis. Rarely, pulmonary hypertension secondary to obliteration of the pulmonary vasculature occurs. 

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