2010 Hong Kong Reference Framework for Hypertension Care for ...

Module 3 Secondary Hypertension 1,2Table 1. Identifiable causes of hypertension (the ABCDE mnemonic)A • Accuracy of diagnosis• obstructive sleep ApneaB • renal artery Bruits (renovascular disease noise)• Bad kidneys (renal parenchymal disease)C • excess Catecholamines• Coarctation of the aorta• Cushing's syndromeD • Drugs (immunosuppressive agents, NSAID, COX-2 inhibitors, estrogens /oral contraceptive, weight-loss agents, stimulants, mineralocorticoids,antiparkinsonian, monoamine oxidase inhibitors, anabolic steroids,sympathomimetics)• Diet (high salt intake, excessive alcohol intake, obesity)E • excess Erythropoietin• Endocrine disorders (phaeochromocytoma, primary and secondaryhyperaldosteronism, hyper- or hypothyroidism, parathyroid disease,Cushing syndrome)Table 2. Findings suggestive of secondary hypertensionFindingsDisorder suspectedSnoring, daytime somnolence, obesityHypernatremia, hypokalemia, increased urinaryexcretion of potassiumRenal artery bruits, renal insufficiency,atherosclerotic cardiovascular disease, oedema,elevated blood urea nitrogen and creatinine levels,proteinuriaSystolic/diastolic abdominal bruitUse of sympathomimetics, perioperative setting,acute stress, tachycardiaDecreased or delayed femoral pulses, abnormalchest radiographObstructive sleep apneaHyperaldosteronismRenal parenchymal diseaseRenovascular diseaseExcess catecholaminesCoarctation of aorta1 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings