When should secondary form of hypertension be suspected?

Primary form of hypertension is diagnosed in 95% of all hypertensives. In the remaining patients hypertension is caused by some diseases. The most frequent secondary forms of hypertension are: obstructive sleep apnoea syndrome, parenchymal renal diseases, renal artery stenosis and primary hyperaldosteronism. Diagnosis of secondary hypertension is of great clinical importance. Sometimes the cause of hypertension may be entirely removed and blood pressure completely normalized. Also other complications of the disease may be avoided. Secondary forms of hypertension can be suspected based on characteristic clinical conditions which are found during history taking or physical examination. The most important findings in a patient’s history are: beginning of hypertension in very young or old age, abrupt blood pressure increase in previously well controlled hypertension or resistance to pharmacological therapy. Suspicion of secondary hypertension should be confirmed by additional investigations. Patients with secondary hypertension should be referred to specialist centres to complete diagnosis and induce proper therapy.