You are here

Home » Content

Sekonder Hipertansiyon

Secondary Hypertension

Journal Name:

  • Smyrna Tıp Dergisi

Publication Year:

  • 2016

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Hypertension related to a spesific etiology is termed secondary hypertension. The incidence is higher in children than in adults. Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects 5-10% of the general hypertensive population. Frequent etiological factors include renal parenchymal dissease, primary aldosteronism, renovasculer hypertension and sleep apnea syndrome. The most common cause of secondary hypertension in adults is obstructive sleep apnea syndrome, in children, most common cause is renal parenchymal dissease. OSAS is a clinical syndrome which is characterized with recurrent apnea and hypopnea caused by collapse of upper respiratory system. Chronic glomerulonephritis, poliycystic kidney disease, reflux nephropaty and congenital abnormalities are some diseases in the group of renal parenchymal diseases. Symphatetic nervous system activation is the most important reason for the onset of hypertension in OSAS. Aortic coarctation is the leading reason of hypertension in the group of congenital heart diseases. Aortic coarctation is seen in patients from any age groups and is diagnosed with randomly detected heart murmur and hypertension. Before diagnosing secondary hypertension, mimicking disease should be excluded. Thus it is avoided unnecessary treatment and further examination. After excluded mimicking dissease (such as white coat hypertension, pseudohypertension and using small cuff), patients should be invastigated for etiology of hypertension. Also dietary habits and drug history should be questioned in all hypertensive patients. Anamnesis, physical examination and some biochemical tests may provide guidance for secondary hypertension.
Bookmark/Search this post with
Abstract (Original Language): 
Sekonder hipertansiyon; düzeltilebilir etyolojiye bağlı olarak ortaya çıkan hipertansiyon olarak tanımlanabilir. Çocuklarda ortaya çıkan hipertansiyonun sekonder nedenlere bağlı olma sıklığı erişkinlere oranla daha fazladır. Yaklaşık %5-10 hasta altta yatan düzeltilebilir etyolojinin neden olduğu sekonder hipertansiyona sahiptir. Sık rastlanılan nedenleri renal parankimal hastalıklar, primer hiperaldosteronizm, renovasküler hipertansiyon ve uyku apne sendromu olarak sayılabilir. Erişkinlerde Obstruktif uyku apne sendromu (OSAS) sekonder hipertansiyonun en sık nedeniyken, çocuklarda en sık neden renal parankimal hastalıklardır. OSAS, uyku sırasında üst hava yolunun kollapsı nedeniyle rekürren apne ve hipopneyle karakterize bir sendromdur. Kronik glomerulonefrit, polikistik böbrek hastalığı, reflü nefropatisi, konjenital anomaliler renal parankimal hastalık grubunda yer almaktadır. Sempatik sinir sistemi aktivasyonu OSAS’ da hipertansiyon gelişiminde en önemli role sahiptir. Aort koarktasyonu hipertansiyona neden olan konjenital kardiyovasküler hastalıkların başında gelmektedir. Aort koarktasyonu her yaştan insanda görülebilmekle birlikte, tanısı tesadüfen saptanan üfürüm ve hipertansiyon ile konur. Sekonder hipertansiyon tanısı koymadan önce taklitçi klinik tabloların belirlenip ekarte edilmesi gerekmektedir. Bu sayede gereksiz tedaviler ve ileri tetkiklerden kaçınılmış olunur. Beyaz önlük hipertansiyonu, pseudohipertansiyon ve küçük manşon kullanımı gibi sekonder hipertansiyonu taklit edecek nedenler dışlandıktan sonra hastalar, hipertansiyona neden olacak etyolojiler açısından araştırılmalıdır. Hipertansiyon saptanan kişilerde diyet alışkanlığı, medikal tedaviler sorgulanmalıdır. Anamnez, fizik muayene ve kısa biyokimyasal testler, hipertansiyona neden olabilecek sekonder nedenler açısından yol gösterici olabilir.
FULL TEXT (PDF): 
PDF icon arastirmax-sekonder-hipertansiyon.pdf
  • 1
53
59
  • Turkish

REFERENCES

References: 

1. Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M et al. Guidelines JSH 2014, Chapter 13, Secondary hpertension. Hypertension Research 2014;37:349-61.
2. Rimoldi FS, Scherrer U, Messerli FH. Secondary arterial hypertension: When, who
and how to screen. European Heart Journal 2014;35(19):1245-54.
3. National Institutes of Health. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. National Heart, Lung and Blood Institute 1996;96-3790.
4. Viera AJ, Neutze DM. Diagnosis of Secondary Hypertension: An Age-Based Approach. American Family Physician 2010; 82(12):1471-7.
5. Vural AV. Sekonder Hipertansiyon. In: Ongen Z (ed). Sistemik Arter Hipertansiyonu Etyolojiden Tedaviye. 1.Baskı, İstanbul: Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Komisyonu. 1997;77-81.
6. Winer N. Evaluation and Management of Secondary Hypertension. Contemporary Diabetes. doi 10.1007/978-1-60327-357-2_2
7. Viera AJ, Hinderliter AL. Evaluation and management of the patient with difficult-to-control or resistant hypertension. Am Fam Physician 2009;79(10):863-9.
8. Ker JA. Secondary hypertension. S Afr Fam Pract 2011;53(5):441-2.
9. Rudnick KV, Sackett DL, Hirst S, Holmes C. Hypertension in a family practice. Can Med Assoc J. 1977;117(5):492-497
10. Faselis C, Doumas M, Papademetriou V. Common Secondary Causes of Resistant Hypertension and Rational for Treatment. International Journal of Hypertension 2011;2011:236239.
11. Fletcher EC. Sympathetic over activity in the etiology of hypertension of obstructive sleep apne. Sleep 2003;26(1):15-9.
12. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007;298(8):874-9.
13. Feig DI, Nakagawa T, Karumanchi SA, Oliver WJ, Kang DH, Finch J et al. Hypothesis: Uric asid, nephron number and the pathogenesis of essential hypertension. Kidney Int 2004; 66(1):281-7.
14. Pisoni R, Ahmed MI, Calhoun DA. Characterization and treatment of resistant hypertension. Curr Cardiol Rep 2009;11(6):407-13.
15. Fenstad ER, Kane GC. Update on the management of atherosclerotic renal artery disease. Minerva Cardioangiology 2009;57(1):95-101.
16. Wheatley K, Phil D, Ives N. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009;361(20):1953-62.
17. Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E, Beek FJ et al. Stent placement in patients with atherosclerotic renal artery
Smyrna Tıp Dergisi – 59 –
stenosis and impaired renal function: as randomized trial. Ann Intern Med 2009; 150(12):840-8.
18. Christopher J. Cooper, Timothy P. Murphy, Donald E. Cutlip. Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis. N Engl J Med 2014; 370(1):13-22.
19. Türkiye Endokrinoloji ve Metabolizma Derneği Adrenal ve Gonadal Hastalıklar Çalışma Grubu. TEMD Adrenal ve Gonadal Hastalıklar Kılavuzu-2014. 8.baskı. Ankara: Bayt Bilimsel Araştırmalar Basın Yayın ve Tanıtım Ltd. Şti. 2015;21-40.
20. Arlt W. Disorders of the Adrenal Cortex. In: Longo DL, Kasper DL, Jameson JL, Fauci SA, Hauser SL, Loscalzo J (eds). Harrison’s Principles of Internal Medicine. 18th edition. United States: The McGraw-Hill Companies 2012;2940-61.
21. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M et al. Case detection, diagnosis and treatment of patients with primary aldosteronism: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266-81.
22. Nishikawa T, Saito J, Omura M. Prevalence of primary aldosteronism: Should we screen
for primary aldosteronism before treating hypertensive patients with medication. Endocrine Journal 2007;54(4):487-95.
23. Lenders JW, Keiser HR, Goldstein DS, Willemsen JJ, Friberg P, Jacobs MC et al. Plasma metanefrines in the diagnosis of pheochomocytoma. Ann İntern Med 1995; 123(2):101-9.
24. Nieman KL, Biller BMK, Findling JW, Price JN, Savage MO, Stewart PM et al. The diagnosis of Cushing’s syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93(5):1526-40.
25. Findling JW, Raff H. Cushing sydrome: Important issues in diagnosis and management. J Clin Endocrinol Metab 2006;91(10):3746-53.

Thank you for copying data from http://www.arastirmax.com