Reference — Med-Surg
Secondary Hypertension Reference
Most hypertension is “essential” with no single cause — but a minority has an identifiable, sometimes curabledriver. Knowing the clues that say “look deeper” is the high-yield skill here.
Educational use only. Workup and treatment of secondary hypertension are provider-directed. This reference is an educational aid for recognizing when to suspect a cause. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
When to Suspect Secondary HTN
Think secondary cause when HTN is: resistant (uncontrolled on ≥ 3 drugs including a diuretic), of very early or late onset, severe or abrupt, accompanied by unexplained hypokalemia, episodic spells, or signs pointing to a specific disorder.
Causes & Clues
| Cause | Clue / when to suspect |
|---|---|
| Renal parenchymal disease (CKD) | Most common cause overall; elevated creatinine, proteinuria, known kidney disease |
| Renal artery stenosis | Resistant HTN, an abdominal bruit, a rise in creatinine after starting an ACE inhibitor/ARB; younger women (fibromuscular) or older atherosclerotic |
| Primary hyperaldosteronism (Conn's) | Hypertension with unexplained HYPOKALEMIA and metabolic alkalosis |
| Pheochromocytoma | Episodic spells — the 5 P's: Pressure (paroxysmal HTN), Pain (headache), Palpitations, Perspiration, Pallor |
| Cushing's syndrome | Central obesity, moon face, striae, hyperglycemia, easy bruising |
| Obstructive sleep apnea (OSA) | Loud snoring, witnessed apneas, daytime somnolence, obesity; resistant/nocturnal HTN |
| Coarctation of the aorta | Upper-extremity HTN with lower-extremity hypotension / weak femoral pulses; younger patients |
| Medications / substances | NSAIDs, oral contraceptives, decongestants, stimulants, cocaine, excess alcohol, some immunosuppressants |
NCLEX Pearls
- ✦Suspect secondary HTN with resistant, very early/late, severe, or abrupt hypertension, or unexplained hypokalemia.
- ✦Renal disease is the most common secondary cause; renal artery stenosis classically has an abdominal bruit and a creatinine bump after ACE-I/ARB.
- ✦HTN + unexplained hypokalemia → think primary hyperaldosteronism (Conn's).
- ✦Pheochromocytoma = episodic 5 P's: Pressure, Pain (headache), Palpitations, Perspiration, Pallor.
- ✦Coarctation = upper-extremity HTN with weak femoral pulses / lower-extremity hypotension.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →