Diagnosis

To diagnose secondary hypertension, your doctor will first take a blood pressure reading using an inflatable cuff, just as your blood pressure is measured during a typical doctor's appointment.

Your doctor may not diagnose secondary hypertension based on only one higher than normal blood pressure reading. It may take three to six high blood pressure measurements at separate appointments to diagnose secondary hypertension. These measurements may come from home blood pressure monitoring and ambulatory blood pressure monitoring. With ambulatory blood pressure monitoring, a device takes blood pressure measurements automatically at specific times throughout the day.

Your doctor will also want to do tests that check other markers to pinpoint the cause of your high blood pressure. These could include:

  • Blood tests. Blood tests are often done to check your levels of potassium, sodium, creatinine, blood glucose, and total cholesterol and triglycerides, among others.
  • A urine test (urinalysis). Your doctor may want to check your urine for markers that could show that your high blood pressure is caused by another medical condition.
  • Ultrasound of your kidneys. Many kidney conditions are linked to secondary hypertension. In this noninvasive test, a technician moves a small, hand-held device called a transducer over the area to be tested. The transducer sends sound waves into your body, collects the ones that bounce back and sends them to a computer, which creates images of your kidneys.
  • Electrocardiogram (ECG or EKG). This painless noninvasive test records the electrical signals in your heart. You might have this test if your doctor thinks a heart problem might be causing your secondary hypertension.

    In this test, sensors (electrodes) are attached to your chest and sometimes to your limbs. Wires attach the electrodes to a computer. The computer records the heart's electrical signal information and displays it as waves on a monitor or on paper. This test can quickly reveal the timing and duration of each phase in your heartbeat.

Treatment

Treatment for secondary hypertension involves treating the underlying medical condition with medications or surgery. Once the underlying condition is treated, your blood pressure might decrease or return to normal.

You may need to continue to take blood pressure medication as well, and any underlying medical condition you have may affect your doctor's choice of medication.

Possible drug choices include:

  • Thiazide diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications.

    Diuretics are often generic and tend to be less expensive than other high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Possible side effects of diuretics include weakness, leg cramps and a higher risk of sexual dysfunction.

  • Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in Black people — but they're effective when combined with a thiazide diuretic.

    Possible side effects include fatigue, sleep problems, a slowed heart rate, and cold hands and feet. In addition, beta blockers generally aren't prescribed for people with asthma, as they can increase muscle spasms in the lungs.

  • Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure.

    Like beta blockers, ACE inhibitors don't work as well in Black people when prescribed alone, but they're effective when combined with a thiazide diuretic. Possible side effects include dizziness and coughing. ACE inhibitors should not be taken during pregnancy.

  • Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure or kidney failure.

    These medications have fewer potential side effects than do ACE inhibitors. Angiotensin II receptor blockers should not be used during pregnancy.

  • Calcium channel blockers. These medications help relax the muscles of your blood vessels or slow your heart rate. Calcium channel blockers may work better for some people than ACE inhibitors or beta blockers alone. Possible side effects include water retention, dizziness and constipation.

    Grapefruit juice interacts with some calcium channel blockers, increasing levels of the medication in your blood and putting you at a higher risk of side effects. Ask your doctor or pharmacist if your medication is affected by grapefruit juice.

  • Direct renin inhibitors. These medications relax and widen the arteries by prevention the action of a protein (enzyme) called renin. Renin is released by your kidneys and helps control blood pressure. An example of a direct renin inhibitor is as aliskiren (Tekturna).

    Common side effects of aliskiren include dizziness and diarrhea. If you have diabetes or moderate to severe kidney problems, you shouldn't use aliskiren in combination with ACE inhibitors or angiotensin II receptor blockers.

    Treatment for secondary hypertension can sometimes be complicated. You may need more than one medication combined with lifestyle changes to control your high blood pressure. Your doctor will want to see you more frequently — possibly as often as once a month — until your blood pressure is controlled. Your doctor may also recommend that you keep track of your blood pressure at home.

Lifestyle and home remedies

Healthy lifestyle changes are recommended to keep your heart healthy and your blood pressure low. These include:

  • Eating healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which is found in fruits and vegetables such as potatoes, spinach, bananas and apricots, to help prevent and control high blood pressure. Eat less saturated fat and total fat.
  • Decreasing the salt in your diet. A lower sodium intake — 1,500 milligrams (mg) a day — is appropriate for people 51 years of age and older and for people of any age who are Black or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less.

    While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.

  • Maintaining a healthy weight. If you're overweight, losing even 10 pounds (4.5 kilograms) can lower your blood pressure.
  • Increasing physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
  • Limiting alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men.
  • Not smoking. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
  • Managing stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.

Preparing for your appointment

Your high blood pressure may be discovered during a routine physical. At that point, your primary care doctor may order more tests or refer you to a doctor who specializes in treating whatever the suspected underlying cause of your high blood pressure may be. For example, if your doctor believes that a kidney problem is causing your high blood pressure, you'll likely be referred to a doctor who specializes in treating kidney disorders (nephrologist).

Because appointments can be brief, and there's often a lot to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet for a certain number of hours before your appointment.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking, as well as information on the dose you take for each.
  • Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For secondary hypertension, some basic questions to ask your doctor include:

  • What do you think is causing my high blood pressure?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • Is my high blood pressure temporary or long lasting?
  • What treatments are available for the cause of my high blood pressure and which do you recommend?
  • What types of side effects can I expect from treatment?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any dietary or activity restrictions that I need to follow?
  • What types of lifestyle changes can I make on my own that might help lower my blood pressure?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • How often do I need to come back to have my blood pressure checked?
  • Do I need to check my blood pressure at home? If so, how often?
  • Which type of blood pressure machine is best? Can you help me learn how to use it correctly?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • Has anyone in your family ever been diagnosed with high blood pressure?
  • If yes, do you know if there was an underlying reason for the high blood pressure? For example, does your relative have diabetes or kidney problems?
  • Have you experienced any unusual symptoms?
  • How much salt is in your diet?
  • Has your body weight changed recently?
  • If you were ever pregnant, was your blood pressure elevated during pregnancy?
Jan. 08, 2021
  1. Basile J, et al. Overview of hypertension in adults. https://www.uptodate.com/contents/search. Accessed Jan. 31, 2019.
  2. Papadakis MA, et al., eds. Systemic hypertension. In: Current Medical Diagnosis & Treatment 2019. 58th ed. McGraw-Hill; 2019. https://accessmedicine.mhmedical.com. Accessed Jan. 31, 2019.
  3. McKean SC, et al., eds. Secondary hypertension. In: Principles and Practice of Hospital Medicine. 2nd ed. McGraw-Hill; 2017. https://accessmedicine.mhmedical.com. Accessed Jan. 31, 2019.
  4. Jameson JL, et al., eds. Hypertension. In: Harrison's Manual of Medicine. 29th ed. McGraw-Hill; 2020. https://accessmedicine.mhmedical.com. Accessed Dec. 17, 2020.
  5. Fuster V, et al., eds. Pathophysiology of hypertension. In: Hurst's the Heart. 14th ed. McGraw-Hill; 2017. https://accessmedicine.mhmedical.com. Accessed Jan. 31, 2019.
  6. Bonow RO, et al., eds. Systemic hypertension: Management. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Jan. 31, 2019.

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