Secondary Hypertension: When High Blood Pressure Has a Fixable Cause

Full analysis

About 10% of people diagnosed with high blood pressure have a secondary cause — a correctable underlying condition — rather than primary (cause-unknown) hypertension. Red flags that should prompt further investigation include: blood pressure that doesn't respond to medication, very high readings above 180 mmHg systolic, sudden onset or rapid worsening, and high blood pressure in a young person with no family history or obesity. Conditions to rule out include kidney disease, renal artery narrowing, thyroid disorders, and hyperaldosteronism (excess of a hormone that raises blood pressure, which can be caused by steroid medications or by the adrenal gland itself). Peter Attia recounts a case where a missed adrenal tumor called a pheochromocytoma — which secretes stress hormones — was causing severe, medication-resistant hypertension in an otherwise healthy athlete; removing the tumor normalized his blood pressure completely.