Causes of secondary hypertension

Hypertension caused by kidney disease

Diseases of the kidney parenchyma

These diseases represent 3-4 % of adults suffering from hypertension. All forms of parenchymal damage to the kidney can be accompanied by arterial hypertension. These forms include: 

Chronic glomerulonephritis.

Usually, patients suffering from this condition have previously suffered from acute nephritis with edema, hematuria (bloody urine). The minimal arterial pressure increases more so than the maximal pressure.

In hypertensive disease, however, it is the systolic (maximal) pressure that predominantly increases rather than the minimal (diastolic) pressure. In general, patients suffering from these cases are young.

Chronic pyelonephritis

Patients suffering from this condition have usually undergone frequent urinary tract infections and exhibit dysuria symptoms (burning sensation while peering, pain during urination, frequent urination, etc).

A pyelography would usually indicate deformation or retraction of the pyelon or the calyces, or disruptions of renal function (the latter are usually visible due to the elimination of contrast).  

Polycystic kidney disease

This is usually a familial condition. Bilateral lumbar pain, hematuria, etc are symptoms used in order to establish a diagnosis.  A pyelography is also conducted in this case.

Renovascular hypertension

Renal artery damages or anomalies, such as their stenosis or aneurism, endarteritis, thrombosis as well as their outer compression from some intraabdominal tumor mass, is accompanied by an increase in arterial pressure, due to renal ischemia.

In order to be able to examine the above, arteriography, pyelography or a renal scintigraphy is performed.

Panarteritis nodosa. Patients suffering from this condition suffer from a high fever, intermittent stomach pain, increase in size of peripheral lymph nodes, etc. A muscular or renal biopsy is required for diagnosis in these cases.

Hypertension due to endocrine disease


This disease is a tumor of the chromaffin tissue, which are responsible for releasing catecholamins. The prevalence of pheocromocytoma in hypertensive patients is less than 0.1%. Patients suffer from symptoms similar to paroxysmal hypertension, at least at the onset of the disease.

These symptoms are accompanied by hyperglycemia and an increase of catecholamines in the blood and urine. Examinations such as an MRI or a pyelography are conducted.

Cushing's syndrome

Patients exhibit hypertension as a consequence of the increased production of cortisol from the adrenal gland. The increase of blood cortisol in the blood causes the retention of sodium, while glucocorticoids increase the synthesis of angiotensinogen in the liver.

This causes an increase in the production of angiotensin II, which is a main contributing factor in the increase of arterial pressure. In this condition, patients experience an increase of adipose (fat) tissue mainly in the face and body, reddish stretch marks, osteoporosis, etc.


This condition is characterized by an increased production of growth hormone. Growth hormone is produced and synthesized by the frontal lobe of the pituitary gland. These patients have pronounced, large facial features with bulging foreheads and jaws.

In addition to these, the hands and feet are enlarged. The diagnosis is made by conducting a head scan or MRI.

Diseases of the thyroid gland

The hormones produced by the thyroid interfere in the cardiovascular system. It causes a decrease in resistance of the blood vessels, an increase in: circulating volume, the contractile force of the heart, chronotropic effects such as heart output.

In hyperthyroidism, there is systolic hypertension with normal diastolic pressure, perhaps even lower. In patients who suffer from lowered thyroid gland function, the prevalence of arterial hypertension is around 20%, and the increase in pressure is mostly occurring for the minimal pressure (diastolic).

Primary aldosteronism

Primary aldosteronism is a syndrome which is characterized by hypertension accompanied by increased production of aldosterone, loss of potassium, sodium retention and a decrease in renin secretion.

An increase in aldosterone occurs due to the presence of a tumor in the cortical portion of the adrenal gland. In one third of patients, this adenoma is usually never found. This is due to a diffuse or focal hyperplasia occurring in the adrenal gland.

Hemodynamic hypertension

Coarctation of the aorta or of the aortic isthmus

In this condition, hypertension begins at a young age, and it is usually caused by the narrowing (coarctation) of the aorta behind the origin of the right subclavian artery. There is regional hypertension due to the localization of the condition in the upper half of the body.

Arterial pressure is higher in the upper extremities rather than in the lower ones, which is a subversion of the normal condition.

Morbus basedow (Grave's disease)

This condition can be accompanied by an increase in systolic arterial pressure, as a consequence of the violent contractions of the left ventricle. Exophtalmia (which occurs when the eyes protrude more than normal from the sockets), goiter, tachycardia, tremors, etc, are symptoms which aid in determining a diagnosis.

Hypertension caused by pregnancy

Pre-eclampsia is a form of hypertension which occurs in women giving birth for the first time, usually during the third trimester of their pregnancy. This condition is accompanied by edema and proteinuria.

This condition is probably caused due to the disruption of the balance between vasoconstrictive and vasodilatory prostaglandins.

Hypertension due to consumption of contraceptive substances

Contraceptives can cause an increase in arterial pressure in most women, but true arterial hypertension develops in less than 5% of women who use them. The increase in arterial pressure is mostly due to the estrogen content found in contraceptives.

It is theorized that estrogen can cause an increase in arterial pressure due to its potential water-retentive properties.

Medically Reviewed by a doctor on 26 Mar 2018
Medical Author: Dr. med. Diana Hysi