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Hypertension, Secondary and Resistant

George H. Maxted, MD, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

Uncontrolled hypertension (HTN) comprises the following entities (see “Alert” below): 
  • Resistant HTN: defined as blood pressure that remains above goal in spite of the concurrent use ...

DIAGNOSIS

HISTORY

  • Ask or review at every visit: “The Big Four” SANS mnemonic: (i) Salt intake, (ii) Alcohol intake, (iii) NSAID use, (iv) Sleep (author’s suggestion, based on reference listed)

  • Review ho...

TREATMENT

  • Treatment modality depends on etiology of HTN. Please see each etiology listed for information on proper treatment.

  • Emphasize adherence to JNC 8 and/or AHA/ACC guidelines, with emphasis on li...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Encourage aerobic activity of 30 min/day, depending on patient’s condition. 

DIET

  • Reduced salt may lower BP in some patients.

  • Recommend the Mediterranean diet or DAS...

REFERENCES

1
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Commit...

ADDITIONAL READING

  • Agarwal R, Bills JE, Hecht TJ, et al. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analy...

SEE ALSO

Aldosteronism, Primary; Coarctation of the Aorta; Cushing Disease and Cushing Syndrome; Hyperparathyroidism; Hypertension, Essential; Hyperthyroidism; Pheochromocytoma 

CODES

ICD10

  • I15.9 Secondary hypertension, unspecified

  • I15.8 Other secondary hypertension

  • I15.0 Renovascular hypertension

  • I15.1 Hypertension secondary to other renal disorders

  • I15.2 Hypertension secondary t...

CLINICAL PEARLS

  • Onset of HTN in adults >60 years of age is a strong indicator of secondary HTN.

  • Common causes of resistant HTN: OSA, excessive salt intake, medication nonadherence, alcohol, NSAIDs

  • Co...

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