Wofford Marion R., King Deborah S., Wyatt Sharon B., Jones Daniel W.
Division of Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
J Clin Hypertens (Greenwich). 2000 Mar;2(2):124-131.
Of hypertensive patients, 95% have primary (essential) hypertension. The remaining 5% of adults with hypertension have an identifiable or "secondary" disorder responsible for the elevated blood pressure. Although relatively rare, the diagnosis of secondary hypertension is important as these forms require specific treatments based on the underlying pathophysiology and are potentially curable. Secondary causes of hypertension include renal disease, such as chronic parenchymal disease and renovascular hypertension, a number of endocrinopathies, such as primary aldosteronism, pheochromocytoma, or thyroid disease, as well as a variety of miscellaneous causes including obstructive sleep apnea and substance abuse. An evaluation for secondary causes in all hypertensive patients is not necessary or cost effective. Clinical clues obtained from a careful history, physical examination, and laboratory assessment guide the clinician through an appropriate evaluation for identifiable causes. A combination of the clinician's index of suspicion and interpretation of data provide guidance in the choice of diagnostic tests and therapies to target the mechanisms contributing to poor blood pressure control. (c)2000 by Le Jacq Communications, Inc.
在高血压患者中，95%患有原发性（特发性）高血压。其余5%的成年高血压患者有可识别的或“继发性”疾病导致血压升高。虽然相对罕见，但继发性高血压的诊断很重要，因为这些类型需要根据潜在的病理生理学进行特定治疗，并且有可能治愈。高血压的继发性病因包括肾脏疾病，如慢性实质性疾病和肾血管性高血压，一些内分泌疾病，如原发性醛固酮增多症、嗜铬细胞瘤或甲状腺疾病，以及各种其他病因，包括阻塞性睡眠呼吸暂停和药物滥用。对所有高血压患者进行继发性病因评估既不必要也不具有成本效益。通过仔细的病史、体格检查和实验室评估获得的临床线索，可指导临床医生进行适当的可识别病因评估。临床医生的怀疑指数和数据解读相结合，为选择诊断测试和针对导致血压控制不佳的机制的治疗方法提供指导。（版权所有2000，Le Jacq通信公司）
