Objectives:

Identify situations suggestive of secondary hypertension (SH). Review the pathophysiology, clinical and/or laboratory manifestations, diagnosis, and treatment of the main forms of secondary hypertension as well as establish the role of the family doctor in its approach based on the most recent evidence.

Data sources:

MEDLINE/PubMed, The Cochrane Library, UpToDate, U.S. Preventive Services Task Force, and guidelines from Direção-Geral da Saúde.

Methods:

Scientific articles were searched on evidence-based medicine online platforms using the keywords ‘Secondary Hypertension’ and ‘Primary Health Care’. The research was conducted in July 2019 and the selection of articles was based on the title, abstract, and publication date. Clinical guidelines were also consulted.

Results:

SH should be suspected in situations of resistant hypertension, onset of hypertension before age 30 in a patient without risk factors, sudden increase or instability in basal blood pressure, malignant or accelerated hypertension, the onset of diastolic hypertension in the elderly, hypertension associated with hydro electrolytic disorders or hypertension with clinical features suggestive of a specific etiology. In children and adolescents, the main causes of SH are renal parenchymal diseases, whereas in adults the common causes are obstructive sleep apnea syndrome, renal parenchymal diseases, renal artery stenosis, primary hyperaldosteronism, and pheochromocytoma. Recognition of clinical and/or laboratory manifestations suggestive of the etiology of SH should guide screening tests for further treatment or referral.

Conclusion:

Evaluating secondary causes in all hypertensive patients is not cost-effective, so only patients with characteristics suggestive of SH should be studied. Properly performing and interpreting screening tests is critical for the referral and treatment of patients with SH.

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