Primary and Secondary Causes of Hypertension - Differential Diagnosis Algorithm

Primary (Essential) (95%) - Onset between age 20 and 50. Positive family history. No features of secondary hypertension.

 • Long-standing

 • Uncontrolled

 • Drug Withdrawal

Mislabelled - Repeatedly normal blood pressure when taken at home, work or when using an ambulatory monitor.

 • White-coat Hypertension

 • Masked Hypertension

Secondary Causes (5%) - Onset age < 20 or > 50 years, No family history. Hypertensive urgency. Resistant hypertension.

 - Exogenous

     • Corticosteroids

     • Oral Contraceptive Pills

     • Cocaine

     • Black licorice

     • Medications

 - Renal

     • Renal parenchymal disease - CKD, AKI, Glomerulonephritis

     • Renovascular disease (unilateral and bilateral renal artery stenosis)

 - Mechanical

     • Aortic coarctation

     • Obstructive Sleep Apnea

 - Endocrine

     • Glucocorticoid excess (Cushing syndrome or disease)

     • Catecholamine excess (pheochromocytoma)

     • Mineralocorticoid excess (primary aldosteronism)

     • Hyperthyroidism (mainly systolic hypertension)

     • Hypothyroidism (mainly diastolic hypertension)

     • Hyperparathyroidism

     • Pregnancy (Gestational hypertension)



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