Secondary Hypertension: Diagnosis and Management

Abstract

Secondary hypertension accounts for approximately 5-10% of all cases of elevated blood pressure and arises from an identifiable underlying cause. Recognising these conditions is critical, as targeted therapy can lead to cure or substantial improvement in blood pressure control and reduction of cardiovascular risk. The most common aetiology is primary aldosteronism, seen in up to 10% of cases, with other common aetiologies being renovascular disease, chronic kidney disease, and endocrinopathies. Less frequent causes include monogenic syndromes (Liddle’s, Gordon’s, apparent mineralocorticoid excess), vascular conditions such as Takayasu arteritis and polyarteritis nodosa, and certain medications. Accurate diagnosis relies on careful clinical assessment, biochemical screening, and confirmatory imaging or genetic testing where appropriate. Advances in hormonal assays, cross-sectional imaging, and genetic sequencing have refined diagnostic algorithms and facilitated earlier detection. Management is centred on correcting the underlying cause, through surgical resection, angioplasty, targeted pharmacotherapy, or cessation of offending agents, alongside optimal antihypertensive therapy.