Surgical Hypertension: Evaluation and Treatment

Hypertension affects 40–50 million people in the United States; the majorities (90–95%) of the cases are classified as essential hypertension. Secondary hypertension is clinically important because it may be reversible and hence, a search for the cause is warranted. Secondary hypertension has several causes. Renal parenchymal disease is the most common cause followed by renovascular disease and various other disorders, including hyperaldosteronism, pheochromocytoma, and coarctation of the aorta. One should have a high index of suspicion for secondary hypertension in patients with resistant or severe hypertension, onset in younger (<30 years) or older patients (>55 years), abrupt onset, rapid worsening of pressure after initially good control, those with renal bruits, or absent or delayed femoral pulses. Although the end result is hypertension, the presenting signs and symptoms of each of the conditions listed below may vary greatly.