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Endocrine Hypertension

Hypertension (HT) is the most prevalent cardiovascular disorder and a major public health problem in the United States as well as worldwide. The relationship between blood pressure (BP) and cardiovascular risk is continuous, consistent, and independent of other risk factors the higher the BP, the greater the chance of myocardial infarction, heart failure, stroke, end-stage renal disease, peripheral vascular disease, and mortality from all causes.

Approximately 90% of individuals with HT have primary (essential) HT, the root causes of which are still being explored. Of the causes of remediable HT (10%), the most prevalent conditions by far are primary aldosteronism (5%–10%) and renal vascular HT (1%–5%).

Essentially, all of the specifically remediable causes of HT are endocrine disorders.

Multiple endocrine systems have been demonstrated to play a role in primary HT, renin-angiotensin system (RAS); mineralocorticoids mineralocorticoid receptors (MRs); catecholamines and the sympathetic nervous system (SNS); the renal dopaminergic system; nitric oxide, endothelin, and cyclooxygenase metabolites; insulin and insulin resistance; the kinin system; vasopressin; and cardiotonic steroids.

DEFINITIONS Hypertension — The following definitions were suggested in 2003 by the seventh report of the Joint National Committee (JNC 7) based upon the average of two or more properly measured readings at each of two or more visits after an initial screen Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg Prehypertension: systolic mmHg or diastolic mmHg

Hypertension: Stage 1: systolic mmHg or diastolic mmHg Stage 2: systolic ≥160 or diastolic ≥100 mmHg

GENERAL CLINICAL CLUES Severe or resistant hypertension. Resistant hypertension is defined as the persistence of hypertension despite concurrent use of adequate doses of three antihypertensive agents from different classes, including a diuretic. An acute rise in blood pressure developing in a patient with previously stable values. Age less than 30 years in non-obese, non-black patients with a negative family history of and no other risk factors (eg, obesity) for hypertension. Malignant or accelerated hypertension (eg, patients with severe hypertension and signs of end-organ damage such as retinal hemorrhages or papilledema, heart failure, neurologic disturbance, or acute kidney injury). Proven age of onset before puberty.

The most common causes of endocrine hypertension excess production of mineralocorticoids (i.e. primary hyperaldosteronism), catecholamines (pheochromocytoma), thyroid hormone glucocorticoids (Cushing's syndrome).

The importance of endocrine mediated hypertension, often produced in excess by a tumor disease-specific targeted antihypertensive therapy can be implemented, in some cases, surgical intervention may result in complete cure.

Primary aldosteronism Pheochromocytoma Congenital adrenal hyperplasia: 11beta-hydroxylase deficiency 17alpha-hydroxylase deficiency Cushing’s Syndrome Glucocorticoid Resistance

Insulin Resistance Hyperparathyroidism Hyperthyroidism Hypothyroidism Acromegaly

Testosterone deficiency growth hormone deficiency