이차성 고혈압의 몇 가지 원인들에 대한 임상 특징

Age less than 30 years with no family history of hypertension and no obesity → 2ndary HTN 평가

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이차성 고혈압의 몇 가지 원인들에 대한 임상 특징

Disorder	Suggestive clinical features
General	Severe or resistant hypertension An acute rise in blood pressure over a previously stable value Proven age of onset before puberty Age less than 30 years with no family history of hypertension and no obesity
Renovascular disease	Unexplained creatinine elevation and/or acute and persistent elevation in serum creatinine of at least 50% after administration of ACE inhibitor, ARB, or renin inhibitor Moderate to severe hypertension in a patient with diffuse atherosclerosis, a unilateral small kidney, or asymmetry in kidney size of more than 1.5 cm that cannot be explained by another reason Moderate to severe hypertension in patients with recurrent episodes of flash pulmonary edema Onset of hypertension with blood pressure >160/100 mmHg after age 55 years Systolic or diastolic abdominal bruit (not very sensitive)
Primary kidney disease	Elevated serum creatinine concentration Abnormal urinalysis
Drug-induced hypertension: Oral contraceptives Anabolic steroids NSAIDs Chemotherapeutic agents (eg, tyrosine kinase inhibitors/VEGF blockade) Stimulants (eg, cocaine, methylphenidate) Calcineurin inhibitors (eg, cyclosporine) Antidepressants (eg, venlafaxine)	New elevation or progression in blood pressure temporally related to exposure
Pheochromocytoma	Paroxysmal elevations in blood pressure Triad of headache (usually pounding), palpitations, and sweating
Primary aldosteronism	Unexplained hypokalemia with urinary potassium wasting; however, more than one-half of patients are normokalemic
Cushing's syndrome	Cushingoid facies, central obesity, proximal muscle weakness, and ecchymoses May have a history of glucocorticoid use
Sleep apnea syndrome	Common in patients with resistant hypertension, particularly if overweight or obese Loud snoring or witnessed apneic episodes Daytime somnolence, fatigue, and morning confusion
Coarctation of the aorta	Hypertension in the arms with diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs Left brachial pulse is diminished and equal to the femoral pulse if origin of the left subclavian artery is distal to the coarct
Hypothyroidism	Symptoms of hypothyroidism Elevated serum thyroid stimulating hormone
Primary hyperparathyroidism	Elevated serum calcium

ACE: angiotensin-converting enzyme; ARB: angiotensin II receptor blocker; NSAID: nonsteroidal antiinflammatory drug; VEGF: vascular endothelial growth factor.

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REF. UpToDate 2020.12.05

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