Types of Hypertension

Types of hypertension

There are two types of hypertension

  1. Primary hypertension
  2. Secondary hypertension
For primary hypertension click here

Secondary hypertension:

Only 5% hypertensive patients suffers from secondary hypertension.

Why secondary hypertension is called secondary?

It is called secondary hypertension because it is secondary to other diseases,  there is a disease which is known as primary disease and because of this primary disease person develop hypertension so that’s why it is known as secondary hypertension.

Causes of secondary hypertension:

The cause of secondary hypertension is known.  Major causes of secondary hypertension are

·       Hyperaldosteronism

·       Chronic kidney disease

·       Renal artery sterosis

·       Pheochromocytoma

·       Sleep apnea

·       Metabolic syndrome

·       Diabetes mellitus

How Hyperaldosteronism cause hypertension?


Hyperaldosteronism is a condition in which there is the excessive production of Aldosterone. Hyperaldosteronism is a endocrine disorder.

Causes of Hyperaldosteronism:

In majority cases this is cause by the benign tumour of adrenal gland, hyperplasia of adrenal gland or it is also hereditary.

Aldosterone is responsible for the retention of sodium ion and water. Sodium ion and water retention increases the blood volume, cardiac output and which increases the blood pressure.

Hypokalemia (low potassium ion concentration) + uncontrolled hypertension (usually early in young age) + low renin concentration this indicates that you are suspect of Hyperaldosteronism.  Because Aldosterone responsible for increasing in the secretion of potassium ions and retaining sodium ions.

Clinical features of Hyperaldosteronism:

·       Along with muscle weakness

·       Nausea

·       Vomiting

·       Spasm

·       Cardiac arrhythmias

·       Fatigue

·       In some cases muscle tremors

·       Uncontrolled hypertension

·       Oedema (due to accumulation of fluids because Aldosterone retain fluids)

Treatment of Hyperaldosteronism:

When it is caused by tumour so the surgery is ultimate treatment.

Normally you will also take Aldosterone antagonist.

Spironolactone + other blood pressure lowering medications. But the ultimate treatment is surgery.

How chronic kidney disease cause hypertension?

Chronic kidney disease:

Kidney is responsible for regulating blood volume. When kidney not functioning properly there will be no formation of urine, no excretion of water and waste so all of them accumulate in body this will result in fluid accumulation blood volume increases and thus increasing blood pressure and cause hypertension.

How renal artery sterosis cause hypertension?

Renal artery sterosis:

Sterosis means narrowing of arteries,  so in renal artery sterosis may decrease diameter of renal arteries.  Mostly because of atherosclerotic plaque, deposition of lipids cause narrowing of renal artery either one artery or both artery this condition known as renal artery sterosis.

Then there will be decrease blood flow to the renal system to the kidneys,  decreased blood flow or hypo perfusion is stimulant of renin secretion. Due to this blood pressure is increased and cause hypertension.

How pheochrromocytoma cause hypertension?


Pheochrromocytoma is a tumour of chromaffin cells of adrenal gland which are responsible for secreting norepinephrine and epinephrine. Both are responsible for increasing blood pressure so these patients usually suffer from severe uncontrollable hypertension,  severe sweating and tachycardia. All sympathetic nervous system effects are exaggerated.

Diagnosis of pheochrromocytoma:

·       Pheochrromocytoma diagnosis is

·       CT scan

·       MRI

·       Biopsies

Norepinephrine and epinephrine and their metabolites concentration is more than normal in blood.

Treatment of pheochrromocytoma:

Ultimate Treatment of pheochrromocytoma  is surgery or before surgery we give blood pressure medicines particularly alpha blockers like prazosin , terazosin , texazosin.

How sleep apnea cause hypertension?

Sleep apnea:

What is apnea?

Apnea means lack of spontaneous breathing.

And lack of spontaneous breathing while sleeping is known as sleep apnea.

In normal peoples there are also lack of spontaneous breathing while sleeping.  While sleeping pharynx muscles is relaxed that’s why air diameter decreases but it still remain sufficient to allow the air .

In some patient it is that much relaxed and these patients have already less diameter than normal people then due to this air passage is blocked then person is unable to breath .

In these patients apnea episodes usually last for more than 10 seconds (>10 sec , they can’t breath for 10 seconds). This occur 300-500 times at a night. Frequency and duration of apnea is more than normal peoples.

How snoring occur? /

How we do snoring?

In snoring there is silence and sound , silence is apnea at that time he/she is not breathing pharynx is blocked. Due to this carbon dioxide concentration is increased and oxygen concentration is decreased. Then you start forceful respiration, due to forceful respiration you do snoring.

Due to forceful respiration we need energy and for energy sympathetic nervous system is activated. So in those patients sympathetic nervous system is more active than parasympathetic nervous system as compare to normal persons.

How baroceptors threshold is increased?

Due to sympathetic nervous system activation blood pressure is high continuously, baroceptor send signal at 120 but due to continuous high blood pressure they are adopt by high pressure then they not send signal on 120 instead send signal on 140 mmHg . They consider 120 is normal because every time is 120 so they will not active at 120.

When continuously sympathetic nervous system is activated then baroceptors threshold is increased so blood pressure regulating mechanism will not activated and blood pressure is not down.

People who suffer from sleep apnea they are at greater risk of developing cardiovascular diseases. Obese and elderly people usually suffer from sleep apnea.

Obese people have more fat deposition in their neck , fat deposition put pressure on pharynx,  when pharynx relax during sleep fat deposition compressed it due to tjis compression they suffer from sleep apnea.

Patient who suffer from nasal blockage,  enlarge tonsils,  enlarge tongue are at the greater risk of developing sleep apnea.

Treatment of sleep apnea:

Maintain pressure. Best to do is surgery,  remove tonsils (tonsillectomy), remove excessive fat.

How metabolic syndrome cause hypertension?

Metabolic syndrome:

Metabolic syndrome is a condition in which obesity,  glucose intolerance,  diabetes mellitus,  dyslipidemia and insulin resistance is present is called metabolic syndrome.

These patients are at a greater risk of developing hypertension.

BMI (body mass index) for asian

Normal = 18.5 – 22.9 kg/m2

Over weight = 23 – 27.5 kg/m2

Obese = > 27.5 kg/m2

Under weight = < 18.5 kg/m2

How diabetes mellitus cause hypertension?

Diabetes mellitus:

Diabetes mellitus damages blood vessels,  increase viscosity of blood by increasing glucose in blood thus increasing total peripheral resistance.

When no laminar flow and have turbulent flow , more will be the friction and damage the blood vessels.  When epithelium is damaged nitric oxide is decreased and increased the production of endothelin.

Blood is viscous and requires more blood pressure for pushing . Cause inflammation, cause kidney damage/ kidney failure.  These all lead to hypertension.

Clinical presentation of hypertension:

Hypertension is asymptomatic in majority cases That’s why called silent killer. Some time resulted target organ damage this damage is symptom.

In some cases cause headaches,  blurred vision,  tachycardia and shortness of breathing,  some time very high chest pain.

Chest measurements for hypertension:

Male = 102 cm

Female = 88 cm

They are at greater risk of developing of cardiovascular diseases.

For epidemiology and stages of hypertension and much more about hypertension click here

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What is hypertension?

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What is Hyperaldosteronism?

Hyperaldosteronism in hypertension

Causes of Hyperaldosteronism

Clinical features of Hyperaldosteronism

Treatment of Hyperaldosteronism

How Chronic kidney disease cause hypertension ?

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How pheochrromocytoma cause hypertension?

What is Pheochrromocytoma?

Diagnosis of pheochrromocytoma

Treatment of pheochrromocytoma

How sleep apnea cause hypertension?

Sleep apnea:

What is apnea?

How snoring occur?

How we do snoring?

What causes snoring while sleeping?

How baroceptors threshold is increased?

Treatment of sleep apnea

How metabolic syndrome cause hypertension?

What is Metabolic syndrome?

How diabetes mellitus cause hypertension

BMI for Asians

Clinical presentation of hypertension

Chest measurements for hypertension

How much is chest measurement of female for hypertension?

How much is chest measurement of male for hypertension?

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