Chronic hypertension causes: Difference between revisions

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Latest revision as of 14:01, 17 May 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian

Overview

Secondary hypertension is only responsible for 5% of cases of chronic hypertension whereas primary hypertension (also known as essential hypertension where no identifiable cause is identified) is responsible for 95% of cases.^[1] Common causes of secondary hypertension include obstructive sleep apnea, hyperaldosteronism, kidney diseases, excess catecholamines, coarctation of the arota, cushing syndrome among other diseases.

Chronic hypertension

Primary hypertension
(also known as essential hypertension)
(95% of the cases)

Secondary hypertension

(5% of the cases)

Primary Hypertension

When a full evaluation yields no clear etiology for the elevated blood pressure, the latter is identified as primary hypertension. Primary or essential hypertension is considered a chronic disease requiring lifelong treatment and follow-up. If an underlying disease is identifiable as the cause, secondary hypertension is diagnosed. Secondary hypertension is a potentially curable condition in most cases.^[2] In comparison, the prevalence of primary hypertension is significantly higher than secondary hypertension, where only 5-10% of patients have a secondary etiology^[1] Classically, the common age range for the presentation of primary hypertension is 30 to 55 years^[3], but age alone should never warrant a diagnosis of primary hypertension without a proper work-up.

Secondary Hypertension

When to Suspect Secondary Hypertension

It is not cost effective to evaluate all hypertensive patients for secondary hypertension. ^[2] There are certain clinical scenarios, though, that should prompt further evaluation.

Early Onset Hypertension Under Age 30

Primary hypertension generally first occurs between 30 and 55 years. Onset of hypertension before puberty and before age 30 in the absence of risk factors should raise suspicion for secondary hypertension.

Abrupt Onset of Hypertension in A Normotensive Patient

Rapidly Progressive Hypertension or a Hypertensive Emergency or Urgency

Refractory Hypertension

Evaluation of Secondary Hypertension

Evaluation of secondary hypertension

Investigation should be limited for patients with clues suggestive of potentially correctable causes.

❑ Presence of clues for renovascular hypertension (most common potentially correctable cause)?^[4]^[5]

❑ Onset of hypertension before the age of 30 years

❑ Onset of severe hypertension (SBP ≥180 mm Hg and/or DBP ≥120 mm Hg) after the age of 55 years

❑ New azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent

❑ Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm

❑ Sudden, unexplained pulmonary edema

❑ Accelerated hypertension (sudden and persistent worsening of previously controlled hypertension)

❑ Resistant hypertension (failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic)

❑ Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage, i.e., acute renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, and/or advanced [grade III to IV] retinopathy)

❑ Unexplained renal failure in the absence of proteinuria or an abnormal urine sediment

❑ Multivessel coronary artery disease

❑ Unexplained congestive heart failure

❑ Refractory angina

YES

NO

❑ Perform noninvasive diagnostic studies

❑ Duplex ultrasonography

❑ Gadolinium-enhanced magnetic resonance angiography

❑ Computed tomographic angiography (in individuals with normal renal function)

❑ Consider catheter angiography when noninvasive studies are inconclusive

Look for findings suggestive of other identifiable causes

❑ Pheochromocytoma

❑ Paroxysmal pounding headache

❑ Palpitations

❑ Profound perspiration

❑ Pallor

❑ Hand tremor

❑ Hyperaldosteronism

❑ Unexplained hypokalemia with urinary potassium wasting

❑ Obstructive sleep apnea

❑ Daytime somnolence

❑ Snoring

❑ Obesity

❑ Hyperparathyroidism

❑ Hypercalcemia

❑ Hypothyroidism

❑ Elevated TSH

❑ Puffy face

❑ Aortic coarctation

❑ Diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs

Common Causes of Secondary Hypertension

Common causes of secondary hypertension are often memorized by the mnemonic ABCDE:

Letter	Causes of Secondary Hypertension
A	Accuracy, Apnea, Aldosteronism
B	Bruit, Bad Kidneys
C	Catecholamines, Coarctation, Cushing’s Syndrome
D	Drugs, Diet
E	Erythropoitin, Endocrine Disorders

Accuracy

An accurate assessment and re-assessment of blood pressures is an essential first step when a patient presents with high blood pressure. The accuracy of home BP measurements should be confirmed by calibrating the patient's measurement technique with that obtained in the doctor's office.

Apnea

Obstructive sleep apnea (OSA) is a respiratory disease characterized by repetitive narrowing or collapse of the upper airway during sleep^[6] leading to apnea, hypopnea, and a nocturnal decrease in oxygen tension.^[7] Symptoms and signs that might suggest OSA include daytime somnolence, obesity, snoring, and morning headache.^[8] Patients with sleep apnea also tend to have drug resistant hypertension and may retain sodium. Diagnosis is made by polysomnography. Treatment relies on maintaining airway patency at night and includes, among others, the use of continuous positive airway pressure (CPAP).

Aldosterone

Primary (hyporeninemic) and secondary (hyperreninemic) hyperaldosteronism result in excess sodium and water retention with slight hypernatremia along with excretion of potassium resulting in hypokalemia in one half of patients.^[9] Common symptoms of hyperaldosteronism include drug resistant hypertension, fatigue, headache, intermittent paralysis, muscle weakness, and numbness. The most common cause of primary hyperaldosteronism is an aldosterone-producing adenoma (an "aldosteronoma"), i.e. Conn’s Syndrome. Secondary hyperaldosteronism is due to an overactive RAAS, as seen in renin-secreting tumors, renal artery stenosis, pheochromocytoma, and other syndromes. The diagnosis is made by measuring the ratio of plasma aldosterone to plasma renin activity.^[10] It is elevated in primary hyperaldosteronism and decreased/normal with elevated renin in secondary hyperaldosteronism. It should be noted that obesity can also cause aldosterone levels to be elevated. Treatment depends upon the underlying etiology: surgery to resect an adenoma causing primary hyperaldosteronism and spironolactone, an aldosterone antagonist to treat secondary hyperaldosteronism.

Bruit

Renovascular hypertension is due to decreased blood supply to the kidneys secondary to renal artery stenosis and it is the most common correctable cause of secondary hypertension. Atherosclerosis of the renal artery (renal artery stenosis) in older patients above 50 years of age^[11] and fibromuscular dysplasia in younger patients are the most common etiologies.

According to the 2013 ACC/AHA Guidelines for the Management of PAD^[12], diagnostic work-up for renal artery stenosis is indicated in the following conditions:

Class I Recommendations^[12]

Hypertension of any stage before the age of 30
Stage II hypertension (severe hypertension systolic blood pressure > 180 mm Hg or diastolic blood pressure > 120 mm Hg) in patients older than 55 years. If only mild hypertension is present, then renal artery stenosis is the underlying cause in only 1% of patients ^[13], but if the blood pressure is markedly elevated, then the risk of renal artery stenosis goes up 10 to 50 fold.
Accelerated condition of previously controlled hypertension
Resistant hypertension
Malignant hypertension
New azotemia (50% rise in creatinine that is sustained) within one week after administration of an Angiotensin Converting Enzyme (ACE)inhibitor or ARB
Unexplained atrophic kidney or asymmetric kidneys that differ by > 1.5 cm. If the kidney is < 9 cm in size, there is a 75% chance that renal artery stenosis is present.
Severe hypertension, impaired renal function, and recurrent flash pulmonary edema

Class IIa Recommendations^[12]

Unexplained renal failure including patients starting renal replacement therapy

Class IIb Recommendations^[12]

Presence of multi vessel CAD and no clinical clues of ARAS or PAD
Unexplained CHF or refractory angina

Other Indications

Severe hypertension in the presence of polyvascular disease (coronary artery disease or peripheral arterial disease)
A unilateral systolic-diastolic abdominal bruit. Although a bruit is infrequent in documented renal artery stenosis (the sensitivity is only 40% percent) if it is auscultated, it is associated with a very high specificity of 99%.^[14]
The association of race with renal artery stenosis is not clear. Reports that it is observed more often in white patients may be due to reporting bias.^[15]

Definitive diagnosis is made by magnetic resonance angiography (MRA) and renal arteriography.^[16] Other diagnostic methods include duplex ultrasound scanning^[17], and captopril-augmented radio-isotopic renogram^[18]. Treatment is based upon the underlying etiology.

Bad Kidney (Chronic Renal Failure)

Renal parenchymal disease blunts the kidney’s physiological ability to maintain appropriate blood pressure. Notably, hypertension is both a cause and a consequence of renal parenchymal disease; the two are closely associated and may potentiate each other.^[19] The diagnosis is made by demonstration of a decreased GFR. The mechanisms by which renal parenchymal disease leads to the development of hypertension are numerous and include activation of the local RAAS, release of vasoconstrictor cytokines, and inappropriate natriuresis for any given blood pressure.

Catecholamines

Catecholamine excess occurs in several non-disease states, such as acute stress, the administration of medications with sympathomimetic activity, and illicit drug use such as cocaine and these conditions can be ruled out by thorough history taking. Pheochromocytoma, a tumor of the adrenal gland leading to excess secretion of epinephrine, should be considered in young patients with the triad of intermittent hypertensive episodes causing headache, sweating, and tachycardia. However, pheochromocytoma in older adults or a presentation with sustained hypertension is not uncommon. Diagnostic studies to evaluate pheochromocytoma include measurement of plasma free metanephrines and urinary fractionated metanephrines. The diagnostic value of plasma and urinary catecholamines is of limited value given the very short half-life of catecholamines. Treatment is usually by surgical resection of the secreting tumor with appropriate adrenergic blockade.^[20]

Coarctation

Coarctation of the aorta is a congenital heart defect, caused by a narrowing in a segment of the ascending or descending aorta. The diagnosis is often made in a neonate or an infant as a result of a weak femoral pulse or asymmetric brisk brachial pulses. Hypertension occurs as a result of a reduction in the effective circulation at the level of the kidneys which respond by increasing plasma volume which in turn causes hypertension in the upper extremities. Diagnosis is by CT angiography, but can also be made in neonates and infants by ultrasound of the heart and the great vessels. Definitive treatment is by surgical correction and or stenting.

Cushing’s Syndrome

Cushing's syndrome is an endocrine disorder caused by prolonged exposure to high endogenous or exogenous cortisol levels. Hypertension in Cushing’s syndrome has been classically attributed to the mineralocorticoid effects of cortisol. It manifests as an absent fall of nocturnal blood pressure physiologically seen in normotensive subjects with associated disturbance in the adrenocorticotropic hormone-glucocorticoid system.^[21] Symptoms of Cushing's syndrome include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity), a round face often referred to as a "moon face" along with central obesity, excess sweating, proximal muscle weakness, ecchymoses, insomnia, reduced libido, impotence, amenorrhoea, infertility and psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety.^[22] Although an ideal diagnostic test is not considered yet available, clinicians often assess the 24-hour urinary cortisol excretion^[23], a low-dose dexamethasone suppression test^[24], late evening serum or salivary cortisol^[25], and a CRH a following a dexamethasone suppression test to establish the diagnosis.^[26]

Drugs

An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, oral contraceptive pills, some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.^[1]

Diet

In addition to the association of obesity with hypertension, the 2001 study “Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet” concluded that a high sodium diet above the recommended 100 mmol per day (2.4 g of sodium or 6 g of sodium chloride salt) is associated with hypertension. As a result, reduction of sodium levels below 100 mmol per day and following the DASH diet (rich in vegetables, fruits, with low-fat dairy products) can significantly lower BP.^[27] Ingestion of excessive amounts of liquorice can lead to elevation in the blood pressure.

Erythropoietin

Elevated erythropoietin is typically seen in COPD patients who have functional anemia due to chronic hypoxia and in hematologic disorders such as polycythemia. The pathogenesis of erythropoietin-induced hypertension includes increased hematocrit and blood viscosity, altered sensitivity to vasopressors, dysregulated vasodilatory factors, and vascular cell growth causing arterial remodeling and changes in arterial smooth musculature.^[28] Diagnosis and treatment are etiology-dependent.

Endocrine

In addition to the more common endocrine causes of hypertension such as hyperaldosteronism, Cushing’s syndrome, and pheochromocytoma, several other endocrine changes can cause hypertension. Both hypothyroidism and hyperthyroidism can cause hypertension by volume retention and by increased cardiac output, respectively. Also, hyperparathyroidism and hypovitaminosis D can cause hypertension due to poorly understood mechanisms, where parathyroidectomy seems to significantly decrease blood pressure in patients with parathyroid disease and elevated BP.^[29] Acromegaly can also be a cause of hypertension.

Causes by Organ System

Cardiovascular	Aortic regurgitation, aortic dissection, acute severe vascular damage, adams Nance syndrome , aneurysm, aortic coarctation , aortic stenosis, arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly , arteriosclerosis, atheroma, avasthey syndrome , carotid paraganglioma ,Congenital mitral stenosis , eisenmenger's Syndrome , fibromuscular dysplasia of arteries , grange syndrome , hemangiomatosis (familial pulmonary capillary disease), hypertensive heart disease , pulmonary artery agenesis , vasculitis , patent ductus arteriosus, third degree AV block
Chemical / poisoning	Acetaldehyde , aristolochic acid poisoning , arizona Bark Scorpion poisoning , black widow spider envenomation , cadmium poisoning, cocaine, ecstasy abuse , ginseng , heavy metal poisoning, Indian tobacco poisoning, jimsonweed poisoning , lead poisoning , lockwood-Feingold syndrome , mustard tree poisoning , nicotine addiction , pseudoephedrine poisoning , silicosis , toxic mushrooms -- Psychedelic , lobelia poisoning
Dermatologic	No underlying causes
Drug Side Effect	almotriptan, amitriptyline, Asenapine maleate, Atropine, Beractant, Betamethasone valerate, Benzphetamine, Betamethasone dipropionate, Butorphanol, Cidofovir, cocaine, combined oral contraceptive pill, cyclosporine, caspofungin acetate, desipramine, Desmopressin, Desogestrel and Ethinyl Estradiol, Diethylpropion, dihydroergotamine, diflunisal, Dimercaprol, Dipivefrine, doxepin, Drospirenone and Ethinyl estradiol, Eculizumab, Eletriptan, ephedrine, ergotamine, Erythropoietin, Estropipate, etodolac, febuxostat, Florbetapir F-18, formoterol, frovatriptan, gadoterate, glucocorticoid resistance , gadopentetate, Hydrocortisone, Hydroxocobalamin, Indomethacin, imipramine, interferon alfacon-1, isometheptene, Ketorolac tromethamine, Lanreotide, Leuprolide, Levalbuterol, Medroxyprogesterone, Mefenamic acid, Megestrol, Meloxicam, Meloxicam, Meropenem, Metipranolol, Methylene blue, Methylphenidate, Methylprednisolone, Metoclopramide, Methoxy polyethylene glycol-epoetin beta, Mifepristone, Milnacipran hydrochloride, Mirabegron, monoamine oxidase inhibitors, Nabilone, Naphazoline , nasal decongestants, Naproxen and esomeprazole magnesium, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, nortriptyline, NSAIDs, Oxaprozin, Oxcarbazepine, Pentamidine Isethionate, Pergolide, phencyclidine, Phendimetrazine, phenylpropanolamine, Pilocarpine, Piroxicam, Pralidozxime, protriptyline, pseudoephedrine, prednisolone, Prednisone, Ramucirumab, Rasagiline, Repaglinide and Metformin hydrochloride, rizatriptan, Rotigotine, sedative dependence, serotonin toxicity, Sertraline, Sipuleucel-T, Sorafenib, steroid abuse, Sulindac, sumatriptan, Sunitinib, Thalidomide, Tiagabine, Tocilizumab, Tolmetin, Travoprost, Triamcinolone, Valganciclovir hydrochloride, zolmitriptan, Zolmitriptan, Zonisamide
Ear Nose Throat	Nephrosis -- deafness -- urinary tract -- digital malformation , Fitzsimmons-Walson-Mellor syndrome
Endocrine	Carcinoid Syndrome, acromegaly , adrenal incidentaloma , alcohol-induced pseudo-Cushing syndrome , apparent mineralocorticoid excess , congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency, congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency, Conn's syndrome, cushing's disease, cushing's syndrome , diabetes, Familial cushing syndrome , graves disease , hyperadrenalism , hyperparathyroidism , hyperpituitarism , hyperthyroidism, hypothyroidism, isolated secretion of corticosterone, isolated secretion of deoxycorticosterone, mineralocorticoid excess, multiple endocrine neoplasia type 1, myxoedema, pheochromocytoma, primary aldosteronism, primary cortisol resistance, pseudohyperaldosteronism , pseudohypoaldosteronism , Schroeder syndrome 1 , hyperthyroidism, hypoglycemia, isolated secretion of 18-hydroxy-deoxycorticosterone, renin-secreting tumors, dexamethasone sensitive hypertension
Environmental	No underlying causes
Gastroenterologic	Hepatorenal tyrosinemia , pancreatitis, retroperitoneal Fibrosis
Genetic	Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency, congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency, cockayne syndrome , down Syndrome , Fabry's Disease , isolated secretion of 18-hydroxy-deoxycorticosterone, Pierre Robin's sequence , Senior-Loken Syndrome, Turner Syndrome , Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency , Von Hippel-Lindau Disease , Werner syndrome , Williams Syndrome , Gaucher disease type 3 , mucopolysaccharidosis type I Hurler syndrome
Hematologic	Anemia, Atypical Hemolytic uremic syndrome, Catastrophic antiphospholipid syndrome , Essential mixed cryoglobulinemia , Faye-Petersen-Ward-Carey syndrome , hemolytic uremic syndrome , hypereosinophilic syndrome , Liddle's syndrome, Multicentric reticulohistiocytosis , polycythemia , thromboembolism , thrombotic thrombocytopenic purpura
Iatrogenic	No underlying causes
Infectious Disease	Poliomyelitis, meningitis, post streptococcal glomerulonephritis , renal tuberculosis, nipah virus encephalitis
Musculoskeletal / Ortho	Acrodynia , Allain Babin Demarquez syndrome , familial osteodysplasia - Anderson type, Paget's disease of bone , Grange syndrome , Faye-Petersen-Ward-Carey syndrome , oculo skeletal renal syndrome , Thieffry and Sorrell Dejerine syndrome
Neurologic	Guillain-Barre Syndrome, autonomic dysreflexia syndrome , Binswanger's Disease , Brain stem encephalitis, central sleep apnea , choroideremia -- hypopituitarism , disequilibrium syndrome , dysautonomia , hereditary sensory and autonomic neuropathy 3 , increased intracranial pressure, neurofibromatosis syndrome Type II , neurogenic hypertension , nipah virus encephalitis , obstructive sleep apnea , Sneddon Syndrome , upper spinal cord lesions, Wolfram's disease, meningitis, polyradiculitis, quadriplegia, Adams Nance syndrome , glycine encephalopathy - classical neonatal form, pituitary Cancer , Fitzsimmons-Walson-Mellor syndrome
Nutritional / Metabolic	Abdominal obesity metabolic syndrome , acute intermittent porphyria , congenital hepatic porphyria , Gaucher disease type 3, glycine encephalopathy - classical neonatal form, glycine synthase deficiency , gouty nephropathy, liquorice, metabolic syndrome, tyrosinemia , Von Gierke disease IB, increased salt intake, mucopolysaccharidosis type I Hurler syndrome, Fabry's Disease , vitamin D -- adverse effects
Obstetric/Gynecologic	Eclampsia , Fowler-Christmas-Chapple syndrome , gestational hypertension, HELLP syndrome , ovarian dysgenesis, PCOS, pregnancy toxemia /hypertension , twin-twin transfusion syndrome
Oncologic	Endothelin producing tumor, adrenal Cancer , familial adrenal adenoma , renal Cancer , neuroblastoma pituitary Cancer , renin-secreting tumors, rhabdoid tumor , Wilms' tumor , adrenal incidentaloma , familial renal cell carcinoma
Opthalmologic	Isolated Ectopia lentis, oculo skeletal renal syndrome
Overdose / Toxicity	Amphetamine abuse, almotriptan, dihydroergotamine, ergotamine, frovatriptan, isometheptene, rizatriptan, sumatriptan, zolmitriptan, amitriptyline, cyclosporine, desipramine, dexamethasone sensitive hypertension, doxepin, ephedrine, glucocorticoid resistance , imipramine, nasal decongestants, nortriptyline, combined oral contraceptive pill, phencyclidine, phenylpropanolamine, protriptyline, serotonin toxicity, steroid abuse, pseudoephedrine, cocaine
Psychiatric	Anxiety
Pulmonary	Asphyxia , bronchopulmonary dysplasia, COPD , Goodpasture syndrome , pulmonary cystic lymphangiectasis , pulmonary embolism , pulmonary fibrosis /granuloma , pulmonary veno-occlusive disease , pulmonary lymphangiomatosis, respiratory acidosis , respiratory failure , unilateral pulmonary agenesis , hyperventilation, obstructive sleep apnea , Wegener's granulomatosis
Renal / Electrolyte	Bartter's Syndrome, dissection of the renal arteries, acid-base imbalance , acute renal failure , albuminuria , analgesic nephropathy syndrome , autosomal dominant polycystic kidney disease , autosomal recessive polycystic kidney disease , bilateral renal artery stenosis , Bright's Disease , chronic kidney disease , chronic pyelonephritis, congenital membranous glomerulonephritis, congenital stenosis of renal artery, congenital hydronephrosis, diffuse mesangial sclerosis, familial renal cell carcinoma , Fitzsimmons-Walson-Mellor syndrome , glomerulonephritis , hereditary nephritis (X-linked), hypoplastic kidney, IgA nephropathy , kidney arteriovenous fistula , Kimmelstiel-Wilson disease, lupus nephritis , nephrocalcinosis , nephrosclerosis , nephrosis -- deafness -- urinary tract -- digital malformation , nephrotic syndrome , oculo skeletal renal syndrome , Pierson syndrome , Severe infantile polycystic kidneys with tuberous sclerosis , post streptococcal glomerulonephritis , renal artery thrombosis, renal artery stenosis, renal emboli, renal segmental hypoplasia-induced Hypertension , renal tuberculosis, Salcedo syndrome , simple kidney cysts , Thieffry and Sorrell Dejerine syndrome , urinary tract infections , urinary tract obstruction, vesicoureteral reflux , Wegener's granulomatosis , Gitelman's Syndrome, hepatorenal tyrosinemia , Atypical hemolytic uremic syndrome, gouty nephropathy, Goodpasture syndrome
Rheum / Immune / Allergy	Autoimmune Vasculitis , systemic lupus erythematosus, diffuse systemic sclerosis , polyarteritis nodosa , Takayasu arteritis
Sexual	No underlying causes
Trauma	Electrical burns , head injury, skull fracture
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Acquired total lipodystrophy , following kidney transplantation, aging, alcohol intake, alcohol withdrawal, amyloidosis , bone cement implantation syndrome, brachydactyly with hypertension, Carnevale-Canun-Mendoza syndrome , codeine withdrawal , collagen disease, essential hypertension, fever, Gram's syndrome , hypothermia, irradiation, Kashani-Strom-Utley syndrome , lymphomatoid granulomatosis , MSBD syndrome , neuroleptic malignant syndrome , obesity, physical inactivity , Selye syndrome , serotonin syndrome , shaken baby syndrome , stress-induced hypertension , type A personality, Wagener syndrome , pain, post-exercise, transfusion of large blood volumes, white coat hypertension

Causes in Alphabetical Order

Eisenmenger's Syndrome
Electrical burns
Endothelin producing tumor
Ephedrine
Ergotamine
Essential hypertension
Essential mixed Cryoglobulinemia
Fabry's Disease
Familial Renal cell carcinoma
Familial Adrenal adenoma
Familial Cushing syndrome
Faye-Petersen-Ward-Carey syndrome
Fever
Fibromuscular dysplasia of arteries
Fitzsimmons-Walson-Mellor syndrome
Fowler-Christmas-Chapple syndrome
Frovatriptan
Gaucher disease type 3
Gestational hypertension
Ginseng
Gitelman's Syndrome
Glomerulonephritis
Glucocorticoid resistance
Glycine encephalopathy - classical neonatal form
Glycine synthase deficiency
Goodpasture syndrome
Gouty nephropathy
Gram's syndrome
Grange syndrome
Graves Disease
Guillain-Barre Syndrome
Head injury
Heavy metal poisoning
HELLP syndrome
Familial Hemangiomatosis - pulmonary capillary
Familial Osteodysplasia - Anderson type
Hemolytic uremic syndrome
Hepatorenal tyrosinemia
Hereditary nephritis (X-linked)
Hereditary sensory and autonomic neuropathy 3
Hydroxocobalamin
Hyperadrenalism
Hypereosinophilic syndrome
Hyperparathyroidism
Hyperpituitarism
Hypertensive heart disease
Hyperthyroidism
Hyperventilation
Hypoglycemia
Hypoplastic kidney
Hypothermia
Hypothyroidism
IgA nephropathy
Imipramine
Increased intracranial pressure
Increased salt intake
Indian Tobacco Poisoning
Infliximab
Irradiation
Isolated secretion of 18-hydroxy-deoxycorticosterone
Isolated secretion of corticosterone
Isolated secretion of deoxycorticosterone
Isolated Ectopia lentis
Isometheptene
Jimsonweed poisoning
Kashani-Strom-Utley syndrome
Kidney arteriovenous fistula
Renal Cancer
Kimmelstiel-Wilson disease
Lead poisoning
Liquorice
Liddle's syndrome
Lobelia poisoning
Lockwood-Feingold syndrome
Lupus nephritis
Lymphomatoid granulomatosis
Medroxyprogesterone
Meloxicam
Meningitis
Meropenem
Metabolic syndrome
Methylphenidate
Mifepristone
[Milnacipran hydrochloride]]
Mineralocorticoid excess
Monoamine oxidase inhibitors
MSBD syndrome
Mucopolysaccharidosis type I Hurler syndrome
Multicentric Reticulohistiocytosis
Multiple endocrine neoplasia type 1
Mustard tree poisoning
Myxoedema
Nasal decongestants
Nephrocalcinosis
Nephrosclerosis
Nephrosis -- deafness -- urinary tract -- digital malformation
Nephrotic syndrome
Neuroblastoma
Neurofibromatosis syndrome Type II
Neurogenic hypertension
Neuroleptic malignant Syndrome
Nicotine addiction
Nipah virus encephalitis
Norgestrel and Ethinyl estradiol
Nortriptyline
NSAIDs
Obesity

References

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↑ ^12.0 ^12.1 ^12.2 ^12.3 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.
↑ Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H (1985). "Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program". Arch Intern Med. 145 (3): 424–7. PMID 3872106.
↑ Turnbull JM (1995). "The rational clinical examination. Is listening for abdominal bruits useful in the evaluation of hypertension?". JAMA. 274 (16): 1299–301. PMID 7563536.
↑ Svetkey LP, Kadir S, Dunnick NR, Smith SR, Dunham CB, Lambert M; et al. (1991). "Similar prevalence of renovascular hypertension in selected blacks and whites". Hypertension. 17 (5): 678–83. PMID 2022411.
↑ Wofford MR, King DS, Wyatt SB, Jones DW (2000). "Secondary Hypertension: Detection and Management for the Primary Care Provider". J Clin Hypertens (Greenwich). 2 (2): 124–131. PMID 11416635.
↑ AbuRahma AF, Srivastava M, Mousa AY, Dearing DD, Hass SM, Campbell JR; et al. (2012). "Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis". J Vasc Surg. 56 (4): 1052–9, 1060.e1, discussion 1059-60. doi:10.1016/j.jvs.2012.03.036. PMID 22595689.
↑ Aitchison F, Page A (1999). "Diagnostic imaging of renal artery stenosis". J Hum Hypertens. 13 (9): 595–603. PMID 10482969.
↑ Soergel M, Schaefer F (2002). "Effect of hypertension on the progression of chronic renal failure in children". Am J Hypertens. 15 (2 Pt 2): 53S–56S. PMID 11866231.
↑ Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P; et al. (2002). "Biochemical diagnosis of pheochromocytoma: which test is best?". JAMA. 287 (11): 1427–34. PMID 11903030.
↑ Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M; et al. (1988). "Altered circadian blood pressure rhythm in patients with Cushing's syndrome". Hypertension. 12 (1): 11–9. PMID 3397172.
↑ Yudofsky, Stuart C. (2007). The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences (5th ed.). American Psychiatric Pub, Inc. ISBN 1585622397. Unknown parameter |coauthors= ignored (help)
↑ Contreras LN, Hane S, Tyrrell JB (1986). "Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations". J Clin Endocrinol Metab. 62 (5): 965–9. PMID 3958132.
↑ NUGENT CA, NICHOLS T, TYLER FH (1965). "Diagnosis of Cushing's Syndrome; Single Dose Dexamethasone Suppression Test". Arch Intern Med. 116: 172–6. PMID 14315650.
↑ Raff H, Raff JL, Findling JW (1998). "Late-night salivary cortisol as a screening test for Cushing's syndrome". J Clin Endocrinol Metab. 83 (8): 2681–6. PMID 9709931.
↑ Yanovski JA, Cutler GB, Chrousos GP, Nieman LK (1993). "Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing's syndrome from pseudo-Cushing's states". JAMA. 269 (17): 2232–8. PMID 8386285.
↑ Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D; et al. (2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". N Engl J Med. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. PMID 11136953.
↑ Vaziri ND (1999). "Mechanism of erythropoietin-induced hypertension". Am J Kidney Dis. 33 (5): 821–8. PMID 10213636.
↑ Chopra S, Cherian D, Jacob JJ (2011). "The thyroid hormone, parathyroid hormone and vitamin D associated hypertension". Indian J Endocrinol Metab. 15 Suppl 4: S354–60. doi:10.4103/2230-8210.86979. PMC 3230087. PMID 22145139.

Template:WH Template:WS

[pmid12537168-1] 1.0 ^1.1 ^1.2 Onusko E (2003). "Diagnosing secondary hypertension". Am Fam Physician. 67 (1): 67–74. PMID 12537168.

[pmid17462751-2] 2.0 ^2.1 Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA; et al. (2008). "Secondary hypertension: current diagnosis and treatment". Int J Cardiol. 124 (1): 6–21. doi:10.1016/j.ijcard.2007.01.119. PMID 17462751.

[pmid11509166-3] Dosh SA (2001). "The diagnosis of essential and secondary hypertension in adults". J Fam Pract. 50 (8): 707–12. PMID 11509166.

[pmid16549646-4] Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646.

[pmid21963765-5] Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK; et al. (2011). "2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 58 (19): 2020–45. doi:10.1016/j.jacc.2011.08.023. PMID 21963765.

[pmid18250206-6] Eckert DJ, Malhotra A (2008). "Pathophysiology of adult obstructive sleep apnea". Proc Am Thorac Soc. 5 (2): 144–53. doi:10.1513/pats.200707-114MG. PMC 2628457. PMID 18250206.CS1 maint: PMC format (link)

[pmid8872797-7] Silverberg DS, Oksenberg A (1996). "Essential and secondary hypertension and sleep-disordered breathing: a unifying hypothesis". J Hum Hypertens. 10 (6): 353–63. PMID 8872797.

[pmid10593319-8] Victor LD (1999). "Obstructive sleep apnea". Am Fam Physician. 60 (8): 2279–86. PMID 10593319.

[pmid9854120-9] Ganguly A (1998). "Primary aldosteronism". N Engl J Med. 339 (25): 1828–34. doi:10.1056/NEJM199812173392507. PMID 9854120.

[pmid7923898-10] Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC (1994). "High incidence of primary aldosteronism in 199 patients referred with hypertension". Clin Exp Pharmacol Physiol. 21 (4): 315–8. PMID 7923898.

[pmid12196346-11] Chade AR, Rodriguez-Porcel M, Grande JP, Krier JD, Lerman A, Romero JC; et al. (2002). "Distinct renal injury in early atherosclerosis and renovascular disease". Circulation. 106 (9): 1165–71. PMID 12196346.

[pmid23457117-12] 12.0 ^12.1 ^12.2 ^12.3 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.

[pmid3872106-13] Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H (1985). "Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program". Arch Intern Med. 145 (3): 424–7. PMID 3872106.

[pmid7563536-14] Turnbull JM (1995). "The rational clinical examination. Is listening for abdominal bruits useful in the evaluation of hypertension?". JAMA. 274 (16): 1299–301. PMID 7563536.

[pmid2022411-15] Svetkey LP, Kadir S, Dunnick NR, Smith SR, Dunham CB, Lambert M; et al. (1991). "Similar prevalence of renovascular hypertension in selected blacks and whites". Hypertension. 17 (5): 678–83. PMID 2022411.

[pmid11416635-16] Wofford MR, King DS, Wyatt SB, Jones DW (2000). "Secondary Hypertension: Detection and Management for the Primary Care Provider". J Clin Hypertens (Greenwich). 2 (2): 124–131. PMID 11416635.

[pmid22595689-17] AbuRahma AF, Srivastava M, Mousa AY, Dearing DD, Hass SM, Campbell JR; et al. (2012). "Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis". J Vasc Surg. 56 (4): 1052–9, 1060.e1, discussion 1059-60. doi:10.1016/j.jvs.2012.03.036. PMID 22595689.

[pmid10482969-18] Aitchison F, Page A (1999). "Diagnostic imaging of renal artery stenosis". J Hum Hypertens. 13 (9): 595–603. PMID 10482969.

[pmid11866231-19] Soergel M, Schaefer F (2002). "Effect of hypertension on the progression of chronic renal failure in children". Am J Hypertens. 15 (2 Pt 2): 53S–56S. PMID 11866231.

[pmid11903030-20] Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P; et al. (2002). "Biochemical diagnosis of pheochromocytoma: which test is best?". JAMA. 287 (11): 1427–34. PMID 11903030.

[pmid3397172-21] Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M; et al. (1988). "Altered circadian blood pressure rhythm in patients with Cushing's syndrome". Hypertension. 12 (1): 11–9. PMID 3397172.

[22] Yudofsky, Stuart C. (2007). The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences (5th ed.). American Psychiatric Pub, Inc. ISBN 1585622397. Unknown parameter |coauthors= ignored (help)

[pmid3958132-23] Contreras LN, Hane S, Tyrrell JB (1986). "Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations". J Clin Endocrinol Metab. 62 (5): 965–9. PMID 3958132.

[pmid14315650-24] NUGENT CA, NICHOLS T, TYLER FH (1965). "Diagnosis of Cushing's Syndrome; Single Dose Dexamethasone Suppression Test". Arch Intern Med. 116: 172–6. PMID 14315650.

[pmid9709931-25] Raff H, Raff JL, Findling JW (1998). "Late-night salivary cortisol as a screening test for Cushing's syndrome". J Clin Endocrinol Metab. 83 (8): 2681–6. PMID 9709931.

[pmid8386285-26] Yanovski JA, Cutler GB, Chrousos GP, Nieman LK (1993). "Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing's syndrome from pseudo-Cushing's states". JAMA. 269 (17): 2232–8. PMID 8386285.

[pmid11136953-27] Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D; et al. (2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". N Engl J Med. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. PMID 11136953.

[pmid10213636-28] Vaziri ND (1999). "Mechanism of erythropoietin-induced hypertension". Am J Kidney Dis. 33 (5): 821–8. PMID 10213636.

[pmid22145139-29] Chopra S, Cherian D, Jacob JJ (2011). "The thyroid hormone, parathyroid hormone and vitamin D associated hypertension". Indian J Endocrinol Metab. 15 Suppl 4: S354–60. doi:10.4103/2230-8210.86979. PMC 3230087. PMID 22145139.

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@@ Line 1: / Line 1: @@
-__NOTOC__
+ __NOTOC__
-{{Template:Hypertension}}
+{{Chronic hypertension}}
-{{CMG}}; '''Assistant Editor-In-Chief:''' Taylor Palmieri
+{{CMG}}; '''Assistant Editor-In-Chief: '''[[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]
 ==Overview==
-The most common cause of hypertension in 90% of cases is [[essential hypertension]] where no clear identifying underlying cause can be identified, and the [[Hypertension pathophysiology|pathophysiology]] of which is incompletely understood.  There are many secondary causes of hypertension.
+Secondary hypertension is only responsible for 5% of cases of chronic hypertension whereas [[primary hypertension]] (also known as [[essential hypertension]] where no identifiable cause is identified) is responsible for 95% of cases.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168  }} </ref> Common causes of secondary hypertension include [[obstructive sleep apnea]], [[hyperaldosteronism]], [[kidney disease]]s, excess [[catecholamine]]s, [[coarctation]] of the arota, [[cushing syndrome]] among other diseases.
-==The Most Common Cause==
-The most common cause of hypertension is [[essential hypertension]] which accounts for about 90% of cases of elevated blood pressure.
-==Common Causes of Secondary Hypertension<ref>isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:85</ref><ref>isbn=1591032016 Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194-195</ref>==
+{{Familytree/start}}
+{{Familytree | | | A01 | | A01= '''[[Chronic hypertension]]'''}}
+{{Familytree | |,|-|^|-|.| }}
+{{Familytree | B01 | | B02 | B01='''[[Primary hypertension]]''' <br>(also known as [[essential hypertension]]) <br> (95% of the cases)| B02= '''[[Secondary hypertension]]'''<br> <br> (5% of the cases)}}
+{{Familytree/end}}
-In only a small minority of patients with elevated arterial pressure can a specific cause be identified.  An underlying [[endocrine]] or renal defect is most often identified, that if corrected, may restore the blood pressure back to normal.
+==Primary Hypertension==
+When a full evaluation yields no clear etiology for the elevated blood pressure, the latter is identified as primary hypertension. Primary or essential hypertension is considered a chronic disease requiring lifelong treatment and follow-up. If an underlying disease is identifiable as the cause, secondary hypertension is diagnosed. Secondary hypertension is a potentially curable condition in most cases.<ref name="pmid17462751">{{cite journal| author=Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA et al.| title=Secondary hypertension: current diagnosis and treatment. | journal=Int J Cardiol | year= 2008 | volume= 124 | issue= 1 | pages= 6-21 | pmid=17462751 | doi=10.1016/j.ijcard.2007.01.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17462751  }} </ref>  In comparison, the prevalence of primary hypertension is significantly higher than secondary hypertension, where only 5-10% of patients have a secondary etiology<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168  }} </ref>  Classically, the common  age range for the presentation of primary hypertension is 30 to 55 years<ref name="pmid11509166">{{cite journal| author=Dosh SA| title=The diagnosis of essential and secondary hypertension in adults. | journal=J Fam Pract | year= 2001 | volume= 50 | issue= 8 | pages= 707-12 | pmid=11509166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11509166  }} </ref>, but age alone should never warrant a diagnosis of primary hypertension without a proper work-up.
+==Secondary Hypertension==
 ===When to Suspect Secondary Hypertension===
-A secondary cause of hypertension should be suspected if the patient has [[resistant hypertension]].  The AHA Scientific Statement 2008 defines resistant hypertension as a blood pressure which remains above the goal of 140/90 mm Hg despite concurrent use of 3 antihypertensive medications of different classes at optimal doses, including a diuretic.<ref name="pmid18391085">{{cite journal| author=Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD et al.| title=Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. | journal=Hypertension | year= 2008 | volume= 51 | issue= 6 | pages= 1403-19 | pmid=18391085 | doi=10.1161/HYPERTENSIONAHA.108.189141 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18391085  }} </ref>.
+It is not cost effective to evaluate all hypertensive patients for secondary hypertension.  <ref name="pmid17462751">{{cite journal| author=Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA et al.| title=Secondary hypertension: current diagnosis and treatment. | journal=Int J Cardiol | year= 2008 | volume= 124 | issue= 1 | pages= 6-21 | pmid=17462751 | doi=10.1016/j.ijcard.2007.01.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17462751 }} </ref> There are certain clinical scenarios, though, that should prompt further evaluation.
+====Early Onset Hypertension Under Age 30====
+Primary hypertension generally first occurs between 30 and 55 years. Onset of hypertension before puberty and before age 30 in the absence of risk factors should raise suspicion for secondary hypertension.
+====Abrupt Onset of Hypertension in A Normotensive Patient====
+====Rapidly Progressive Hypertension or a Hypertensive Emergency or Urgency====
+====Refractory Hypertension====
+<div class="mw-collapsible mw-collapsed">
+===Evaluation of Secondary Hypertension===
+<div class="mw-collapsible-content">
+{{Familytree/start}}
+{{Familytree|boxstyle=text-align: center; font-size: 90%; padding: 0px; width: 50%;| | | | | | A01 | | | | | | | | | |A01=<div style="padding: 15px;">'''''Evaluation of secondary hypertension'''''</div>}}
+{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px; width: 50%; border-top: 0px;| | | | | | A01 | | | | | | | | | |A01=<div style="padding: 15px;">
+'''Investigation should be limited for patients with clues suggestive of potentially correctable causes.'''
+❑ Presence of clues for renovascular hypertension (most common potentially correctable cause)?<ref name="pmid16549646">{{cite journal| author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al.| title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= e463-654 | pmid=16549646 | doi=10.1161/CIRCULATIONAHA.106.174526 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16549646  }} </ref><ref name="pmid21963765">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK et al.| title=2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 19 | pages= 2020-45 | pmid=21963765 | doi=10.1016/j.jacc.2011.08.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21963765  }} </ref>
+: ❑ Onset of hypertension before the age of 30 years
+: ❑ Onset of severe hypertension (SBP ≥180 mm Hg and/or DBP ≥120 mm Hg) after the age of 55 years
+: ❑ New azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent
+: ❑ Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm
+: ❑ Sudden, unexplained pulmonary edema
+: ❑ Accelerated hypertension (sudden and persistent worsening of previously controlled hypertension)
+: ❑ Resistant hypertension (failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic)
+: ❑ Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage, i.e., acute renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, and/or advanced [grade III to IV] retinopathy)
+: ❑ Unexplained renal failure in the absence of proteinuria or an abnormal urine sediment
+: ❑ Multivessel coronary artery disease
+: ❑ Unexplained congestive heart failure
+: ❑ Refractory angina
+</div>}}
+{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | |,|-|-|-|^|-|-|-|.| | | | | |}}
+{{Familytree|boxstyle=text-align: center; font-size: 90%; padding: 0px;| | A01 | | | | | | A02 |A01=<div style="padding: 10px; font-weight: bold;">YES</div>|A02=<div style="padding: 10px; font-weight: bold;">NO</div>}}
+{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px; border-top: 0px; vertical-align: top; width: 25%;| | A01 | | | | | | A02 |A01=<div style="padding: 10px;">
+❑ Perform noninvasive diagnostic studies
+: ❑ Duplex ultrasonography
+: ❑ Gadolinium-enhanced magnetic resonance angiography
+: ❑ Computed tomographic angiography (in individuals with normal renal function)
+❑ Consider catheter angiography when noninvasive studies are inconclusive</div>
+|A02=<div style="padding: 10px; font-size: 85%;">
+Look for findings suggestive of other identifiable causes
+❑ Pheochromocytoma
+: ❑ Paroxysmal pounding headache
+: ❑ Palpitations
+: ❑ Profound perspiration
+: ❑ Pallor
+: ❑ Hand tremor
+❑ Hyperaldosteronism
+: ❑ Unexplained hypokalemia with urinary potassium wasting
+❑ Obstructive sleep apnea
+: ❑ Daytime somnolence
+: ❑ Snoring
+: ❑ Obesity
+❑ Hyperparathyroidism
+: ❑ Hypercalcemia
-Other features that suggest secondary hypertension include:
+❑ Hypothyroidism
-*Recent onset of hypertension
+: ❑ Elevated TSH
-*Unprovoked [[hypokalemia]] or an inappropriately [[low potassium]] (e.g. a "normal K" on an [[ACE inhibitor]] plus a [[K sparing diuretic]])
+: ❑ Puffy face
-*Presence of [[peripheral arterial disease]]
-*Increase in [[creatine]] with [[ACE inhibition]]
-*Loss of control of previously controlled hypertension
-Before evaluating the patient for secondary hypertension, non-compliance with antihypertensives should be ruled out.  Given its prevalence in the Unites States population, sleep apnea should also be ruled out early in the evaluation.
+❑ Aortic coarctation
+: ❑ Diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs</div>}}
+{{Family tree/end}}
+</div></div>
 ===Common Causes of Secondary Hypertension===
-Common causes of secondary hypertension include:
+Common causes of secondary hypertension are often memorized by the mnemonic ABCDE:
-* [[Anxiety]]: Hypertension is often confused with mental tension, stress and [[anxiety]]. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone probably does not cause it.
+{| border="1" style="border-collapse:collapse; text-align:left; font-size:130%;" cellpadding="5" align="center" width="600px"
-* [[Arteriosclerosis]]
+|-
-* [[Chronic kidney disease]].  This includes diseases such as [[polycystic kidney disease]] or chronic [[glomerulonephritis]].
+|bgcolor="#67e1ff"|'''Letter'''
-* [[Congenital adrenal hyperplasia]]
+|bgcolor="#67e1ff"|'''Causes of Secondary Hypertension'''
-* [[Cushing's syndrome]] due to an excessive secretion of [[glucocorticoids]] which in turn causes the hypertension
+|-
-* Drugs:
+|bgcolor="#f3f3f3"| A
-:*[[Nasal decongestants]] with adrenergic effects
+|Accuracy, Apnea, Aldosteronism
-:*[[NSAIDs]]
+|-
-:*[[Oral contraceptives]]
+|bgcolor="#f3f3f3"| B
-:*[[Steroids]]
+|Bruit, Bad Kidneys
-* [[Fever]]
+|-
-* [[Hyperaldosteronism]] ([[Conn's syndrome]]): Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary [[aldosteronism]] there is a clear relationship between the aldosterone-induced sodium retention and the hypertension. Suspect hyperaldosteronism if the patient has an unusual sensitivity to a diuretic in causing [[hypokalemia]], if there is frequent hypokalemia, and if there is a normal potassium in the setting of ACE inhibition with a potassium spairing diuretic.  The [[plasma renin activity]] is suppressed and there is elevated [[aldosterone]] on [[adrenal vein]] sampling.
+|bgcolor="#f3f3f3"| C
-:*[[Idiopathic hyperaldosteronism]]
+|Catecholamines, Coarctation, Cushing’s Syndrome
-:*[[Liddle's syndrome]] (also called [[pseudoaldosteronism]])
+|-
-:*[[Glucocorticoid remediable aldosteronism]]
+|bgcolor="#f3f3f3"| D
-* [[Hyperthyroidism]]
+|Drugs, Diet
-* [[Hypothyroidism]]
+|-
-* [[Increased salt intake]]
+|bgcolor="#f3f3f3"| E
-* [[Metabolic syndrome]]
+|Erythropoitin, Endocrine Disorders
-* Non-compliance with antihypertensives
+|}
-* [[Obesity]]
-* [[Obstructive sleep apnea]] can cause a rise in [[catecholamines]]
+=====Accuracy=====
-* Perioperative hypertension: this is the development of hypertension just before, during or after surgery.  It may occur before surgery during the induction of anesthesia; intraoperatively e.g. by pain-induced [[sympathetic nervous system]] stimulation; in the early postanesthesia period, e.g. by pain-induced [[sympathetic stimulation]], [[hypothermia]], [[hypoxia]], or hypervolemia from excessive intraoperative fluid therapy; and in the 24 to 48 hours after the postoperative period as fluid is mobilized from the extravascular space. In addition, hypertension may develop perioperatively because of discontinuation of long-term antihypertensive medication.
+An accurate assessment and re-assessment of blood pressures is an essential first step when a patient presents with high blood pressure.  The accuracy of home BP measurements should be confirmed by calibrating the patient's measurement technique with that obtained in the doctor's office.
-* [[Pheochromocytoma]]: Caused by an excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction.  Consider this diagnosis in the patient who has [[headaches]], [[diaphoresis]], [[palpitations]], [[orthostatic hypotension]], hypertension with anesthesia induction and those patients with a [[dilated cardiomyopathy]] (which a [[pheochromocytoma]] can cause) who still have an elevated [[blood pressure]] despite a loss in [[cardiac output]].  This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites ([[vanillylmandelic acid]]).
-* [[Pregnancy]] causing [[gestational hypertension]]
+=====Apnea=====
-* [[Renovascular hypertension]]: Due to [[fibromuscular dysplasia]] and [[renal artery stenosis]].  In both conditions, increased blood pressure occurs due to narrowing of arteries supplying to the kidney.  Decreased perfusion of renal tissue due to [[stenosis]] of a main or branch renal artery activates the [[renin-angiotensin system]].
+[[Obstructive sleep apnea]] (OSA) is a respiratory disease characterized by repetitive narrowing or collapse of the upper airway during sleep<ref name="pmid18250206">{{cite journal| author=Eckert DJ, Malhotra A| title=Pathophysiology of adult obstructive sleep apnea. | journal=Proc Am Thorac Soc | year= 2008 | volume= 5 | issue= 2 | pages= 144-53 | pmid=18250206 | doi=10.1513/pats.200707-114MG | pmc=PMC2628457 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18250206  }} </ref> leading to [[apnea]], [[hypopnea]], and a nocturnal decrease in oxygen tension.<ref name="pmid8872797">{{cite journal| author=Silverberg DS, Oksenberg A| title=Essential and secondary hypertension and sleep-disordered breathing: a unifying hypothesis. | journal=J Hum Hypertens | year= 1996 | volume= 10 | issue= 6 | pages= 353-63 | pmid=8872797 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872797  }} </ref> Symptoms and signs that might suggest OSA include daytime [[somnolence]], [[obesity]], [[snoring]], and [[morning headache]].<ref name="pmid10593319">{{cite journal| author=Victor LD| title=Obstructive sleep apnea. | journal=Am Fam Physician | year= 1999 | volume= 60 | issue= 8 | pages= 2279-86 | pmid=10593319 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10593319  }} </ref> Patients with sleep apnea also tend to have drug resistant hypertension and may retain sodium. Diagnosis is made by polysomnography. Treatment relies on maintaining airway patency at night and includes, among others, the use of continuous positive airway pressure (CPAP).
-:Tests to Assess for Renovascular Hypertension
-:*Renal Ultrasound: Look for a difference in the size of kidneys
+=====Aldosterone=====
-:*CT: Although there is a dye load, there is no Gadollinium which can be toxic with an MRI, the images are better than MRI
+Primary (hyporeninemic) and secondary (hyperreninemic) [[hyperaldosteronism]] result in excess sodium and water retention with slight [[hypernatremia]] along with excretion of [[potassium]] resulting in [[hypokalemia]] in one half of patients.<ref name="pmid9854120">{{cite journal| author=Ganguly A| title=Primary aldosteronism. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 25 | pages= 1828-34 | pmid=9854120 | doi=10.1056/NEJM199812173392507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9854120  }} </ref>  Common symptoms of hyperaldosteronism include drug resistant hypertension, [[fatigue]], [[headache]], intermittent [[paralysis]], [[muscle weakness]], and [[numbness]].  The most common cause of [[primary hyperaldosteronism]] is an aldosterone-producing [[adenoma]] (an "[[aldosteronoma]]"), i.e. [[Conn’s Syndrome]]. [[Secondary hyperaldosteronism]] is due to an overactive [[RAAS]], as seen in renin-secreting tumors, [[renal artery stenosis]], [[pheochromocytoma]], and other syndromes.  The diagnosis is made by measuring the ratio of plasma aldosterone to plasma renin activity.<ref name="pmid7923898">{{cite journal| author=Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC| title=High incidence of primary aldosteronism in 199 patients referred with hypertension. | journal=Clin Exp Pharmacol Physiol | year= 1994 | volume= 21 | issue= 4 | pages= 315-8 | pmid=7923898 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7923898  }} </ref> It is elevated in [[primary hyperaldosteronism]] and decreased/normal with elevated [[renin]] in [[secondary hyperaldosteronism]].  It should be noted that obesity can also cause [[aldosterone]] levels to be elevated.  Treatment depends upon the underlying etiology: surgery to resect an adenoma causing [[primary hyperaldosteronism]] and [[spironolactone]], an aldosterone antagonist to treat [[secondary hyperaldosteronism]].
-:*Indications for Arteriographic Imaging to Rule Out Renovascular Hypertension<ref>J Vasc Interv Rad 2006 17:1383-1398</ref>
-::Class I
+===== Bruit=====
-:::*Hypertension in a patient < 30 yrs old
+[[Renovascular hypertension]] is due to decreased blood supply to the [[kidneys]] secondary to renal artery stenosis and it is the most common correctable cause of secondary hypertension.  [[Atherosclerosis]] of the renal artery ([[renal artery stenosis]]) in older patients above 50 years of age<ref name="pmid12196346">{{cite journal| author=Chade AR, Rodriguez-Porcel M, Grande JP, Krier JD, Lerman A, Romero JC et al.| title=Distinct renal injury in early atherosclerosis and renovascular disease. | journal=Circulation | year= 2002 | volume= 106 | issue= 9 | pages= 1165-71 | pmid=12196346 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12196346  }} </ref> and [[fibromuscular dysplasia]] in younger patients are the most common etiologies.
-:::*Severe increase in blood pressure in a patient > 55 yrs old
-:::*Accelerated increase in BP
+According to the 2013 ACC/AHA Guidelines for the Management of PAD<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>, diagnostic work-up for renal artery stenosis is indicated in the following conditions:
-:::*Resistant increase in BP
-:::*Complicated malignant increase in BP
+====Class I Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>====
-:::*Reduction in [[GFR]] or rise in Cr with [[RAS]] blockade
+*Hypertension of any stage before the age of 30
-:::*> 1.5 cm difference in renal size on ultrasound
+*Stage II hypertension (severe hypertension systolic blood pressure > 180 mm Hg or diastolic blood pressure > 120 mm Hg) in patients older than 55 years. If only mild hypertension is present, then renal artery stenosis is the underlying cause in only 1% of patients <ref name="pmid3872106">{{cite journal| author=Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H| title=Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. | journal=Arch Intern Med | year= 1985 | volume= 145 | issue= 3 | pages= 424-7 | pmid=3872106 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3872106  }} </ref>, but if the blood pressure is markedly elevated, then the risk of renal artery stenosis goes up 10 to 50 fold.
-:::*Flash pulmonary edema
+*Accelerated condition of previously controlled hypertension
-::Class IIa
+*[[Resistant hypertension]]
-:::*Unexplained [[renal failure]]
+*[[Malignant hypertension]]
-::Class IIb
+*New [[azotemia]] (50% rise in [[creatinine]] that is sustained) within one week after administration of an [[Angiotensin Converting Enzyme]] ([[ACE]])inhibitor or [[ARB]]
-:::*Multivessel [[CAD]] or [[PAD]]
+*Unexplained atrophic kidney or asymmetric kidneys that differ by > 1.5 cm. If the kidney is < 9 cm in size, there is a 75% chance that renal artery stenosis is present.
-:::*Unexplained [[CHF]] or refractory angina
+*Severe hypertension, impaired renal function, and recurrent flash [[pulmonary edema]]
-* [[Scleroderma]]
-* [[Stress]]
+====Class IIa Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>====
-* [[White coat hypertension]]
+*Unexplained renal failure including patients starting renal replacement therapy
+====Class IIb Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>====
+*Presence of multi vessel [[CAD]] and no clinical clues of ARAS or PAD
+*Unexplained [[CHF]] or [[refractory angina]]
+====Other Indications====
+* Severe hypertension in the presence of polyvascular disease ([[coronary artery disease]] or [[peripheral arterial disease]])
+* A unilateral systolic-diastolic [[abdominal bruit]]. Although a bruit is infrequent in documented renal artery stenosis (the sensitivity is only 40% percent) if it is auscultated, it is associated with a very high specificity of 99%.<ref name="pmid7563536">{{cite journal| author=Turnbull JM| title=The rational clinical examination. Is listening for abdominal bruits useful in the evaluation of hypertension? | journal=JAMA | year= 1995 | volume= 274 | issue= 16 | pages= 1299-301 | pmid=7563536 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7563536  }} </ref>
+*The association of race with renal artery stenosis is not clear. Reports that it is observed more often in white patients may be due to reporting bias.<ref name="pmid2022411">{{cite journal| author=Svetkey LP, Kadir S, Dunnick NR, Smith SR, Dunham CB, Lambert M et al.| title=Similar prevalence of renovascular hypertension in selected blacks and whites. | journal=Hypertension | year= 1991 | volume= 17 | issue= 5 | pages= 678-83 | pmid=2022411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2022411  }} </ref>
+Definitive diagnosis is made by magnetic resonance angiography (MRA) and renal arteriography.<ref name="pmid11416635">{{cite journal| author=Wofford MR, King DS, Wyatt SB, Jones DW| title=Secondary Hypertension: Detection and Management for the Primary Care Provider. | journal=J Clin Hypertens (Greenwich) | year= 2000 | volume= 2 | issue= 2 | pages= 124-131 | pmid=11416635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11416635  }} </ref> Other diagnostic methods include duplex ultrasound scanning<ref name="pmid22595689">{{cite journal| author=AbuRahma AF, Srivastava M, Mousa AY, Dearing DD, Hass SM, Campbell JR et al.| title=Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis. | journal=J Vasc Surg | year= 2012 | volume= 56 | issue= 4 | pages= 1052-9, 1060.e1; discussion 1059-60 | pmid=22595689 | doi=10.1016/j.jvs.2012.03.036 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22595689  }} </ref>, and captopril-augmented radio-isotopic renogram<ref name="pmid10482969">{{cite journal| author=Aitchison F, Page A| title=Diagnostic imaging of renal artery stenosis. | journal=J Hum Hypertens | year= 1999 | volume= 13 | issue= 9 | pages= 595-603 | pmid=10482969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10482969  }} </ref>. Treatment is based upon the underlying etiology.
+===== Bad Kidney (Chronic Renal Failure)=====
+Renal parenchymal disease blunts the kidney’s physiological ability to maintain appropriate [[blood pressure]]. Notably, [[hypertension]] is both a cause and a consequence of renal parenchymal disease; the two are closely associated and may potentiate each other.<ref name="pmid11866231">{{cite journal| author=Soergel M, Schaefer F| title=Effect of hypertension on the progression of chronic renal failure in children. | journal=Am J Hypertens | year= 2002 | volume= 15 | issue= 2 Pt 2 | pages= 53S-56S | pmid=11866231 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11866231  }} </ref> The diagnosis is made by demonstration of a decreased [[GFR]]. The mechanisms by which renal parenchymal disease leads to the development of hypertension are numerous and include activation of the local [[RAAS]], release of vasoconstrictor [[cytokines]], and inappropriate [[natriuresis]] for any given [[blood pressure]].
+=====Catecholamines=====
+Catecholamine excess occurs in several non-disease states, such as acute [[stress]], the administration of medications with sympathomimetic activity, and illicit drug use such as [[cocaine]] and these conditions can be ruled out by thorough history taking. [[Pheochromocytoma]], a tumor of the adrenal gland leading to excess secretion of [[epinephrine]], should be considered in young patients with the triad of intermittent hypertensive episodes causing [[headache]], [[sweating]], and [[tachycardia]]. However, [[pheochromocytoma]] in older adults or a presentation with sustained hypertension is not uncommon. Diagnostic studies to evaluate pheochromocytoma include measurement of plasma free [[metanephrines]] and urinary fractionated metanephrines.  The diagnostic value of plasma and urinary catecholamines is of limited value given the very short half-life of catecholamines.  Treatment is usually by surgical resection of the secreting tumor with appropriate adrenergic blockade.<ref name="pmid11903030">{{cite journal| author=Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P et al.| title=Biochemical diagnosis of pheochromocytoma: which test is best? | journal=JAMA | year= 2002 | volume= 287 | issue= 11 | pages= 1427-34 | pmid=11903030 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11903030  }} </ref>
+=====Coarctation=====
+[[Coarctation of the aorta]] is a [[congenital heart defect]], caused by a narrowing in a segment of the ascending or [[descending aorta]].  The diagnosis is often made in a neonate or an infant as a result of a weak femoral pulse or asymmetric brisk brachial pulses.  [[Hypertension]] occurs as a result of a reduction in the effective circulation at the level of the [[kidneys]] which respond by increasing plasma volume which in turn causes hypertension in the upper extremities.  Diagnosis is by [[CT angiography]], but can also be made in neonates and infants by ultrasound of the heart and the great vessels. Definitive treatment is by surgical correction and or stenting.
+=====Cushing’s Syndrome=====
+[[Cushing's syndrome]] is an endocrine disorder caused by prolonged exposure to high endogenous or exogenous [[cortisol]] levels.  Hypertension in [[Cushing’s syndrome]] has been classically attributed to the [[mineralocorticoid]] effects of cortisol. It manifests as an absent fall of nocturnal [[blood pressure]] physiologically seen in normotensive subjects with associated disturbance in the adrenocorticotropic hormone-glucocorticoid system.<ref name="pmid3397172">{{cite journal| author=Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M et al.| title=Altered circadian blood pressure rhythm in patients with Cushing's syndrome. | journal=Hypertension | year= 1988 | volume= 12 | issue= 1 | pages= 11-9 | pmid=3397172 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3397172  }} </ref>  Symptoms of Cushing's syndrome include  rapid [[obesity|weight gain]], particularly of the trunk and face with sparing of the limbs ([[central obesity]]), a round face often referred to as a "[[moon face]]" along with central obesity, excess [[sweating]], [[proximal muscle weakness]], [[ecchymoses]], [[insomnia]], reduced [[libido]], [[impotence]], [[amenorrhoea]], [[infertility]] and psychological disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[clinical depression|Depression]] and [[anxiety]].<ref>{{cite book |title=The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences |last=Yudofsky |first=Stuart C. |coauthors=Robert E. Hales |edition=5th |year=2007 |publisher=American Psychiatric Pub, Inc. |isbn=1585622397 }}</ref> Although an ideal diagnostic test is not considered yet available, clinicians often assess the 24-hour urinary [[cortisol]] excretion<ref name="pmid3958132">{{cite journal| author=Contreras LN, Hane S, Tyrrell JB| title=Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations. | journal=J Clin Endocrinol Metab | year= 1986 | volume= 62 | issue= 5 | pages= 965-9 | pmid=3958132 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3958132  }} </ref>, a low-dose [[dexamethasone suppression test]]<ref name="pmid14315650">{{cite journal| author=NUGENT CA, NICHOLS T, TYLER FH| title=Diagnosis of Cushing’s Syndrome; Single Dose Dexamethasone Suppression Test. | journal=Arch Intern Med | year= 1965 | volume= 116 | issue=  | pages= 172-6 | pmid=14315650 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14315650  }} </ref>, late evening serum or salivary cortisol<ref name="pmid9709931">{{cite journal| author=Raff H, Raff JL, Findling JW| title=Late-night salivary cortisol as a screening test for Cushing's syndrome. | journal=J Clin Endocrinol Metab | year= 1998 | volume= 83 | issue= 8 | pages= 2681-6 | pmid=9709931 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9709931  }} </ref>, and a [[CRH]] a following a [[dexamethasone suppression test]] to establish the diagnosis.<ref name="pmid8386285">{{cite journal| author=Yanovski JA, Cutler GB, Chrousos GP, Nieman LK| title=Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing's syndrome from pseudo-Cushing's states. | journal=JAMA | year= 1993 | volume= 269 | issue= 17 | pages= 2232-8 | pmid=8386285 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8386285  }} </ref>
-==Common causes of Resistant hypertension<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref>==
+=====Drugs=====
-*'''Improper blood pressure measurement'''
+An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, [[oral contraceptive pills]], some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168  }} </ref>
-*'''Volume overload'''
+=====Diet=====
-**Excess sodium intake
+In addition to the association of [[obesity]] with hypertension, the 2001 study “Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet” concluded that a high sodium diet above the recommended 100 mmol per day (2.4 g of sodium or 6 g of sodium chloride salt) is associated with hypertension. As a result, reduction of sodium levels below 100 mmol per day and following the DASH diet (rich in vegetables, fruits, with low-fat dairy products) can significantly lower BP.<ref name="pmid11136953">{{cite journal| author=Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al.| title=Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 1 | pages= 3-10 | pmid=11136953 | doi=10.1056/NEJM200101043440101 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11136953  }} </ref>  Ingestion of excessive amounts of [[liquorice]] can lead to elevation in the [[blood pressure]].
-**Volume retention from kidney disease
-**Inadequate [[diuretic]] therapy
-*'''Drug-induced or other causes'''
+=====Erythropoietin=====
-**Non-adherence
+Elevated erythropoietin is typically seen in [[COPD]] patients who have functional anemia due to chronic [[hypoxia]] and in hematologic disorders such as polycythemia. The pathogenesis of erythropoietin-induced hypertension includes increased hematocrit and blood viscosity, altered sensitivity to vasopressors, dysregulated vasodilatory factors, and vascular cell growth causing arterial remodeling and changes in arterial smooth musculature.<ref name="pmid10213636">{{cite journal| author=Vaziri ND| title=Mechanism of erythropoietin-induced hypertension. | journal=Am J Kidney Dis | year= 1999 | volume= 33 | issue= 5 | pages= 821-8 | pmid=10213636 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10213636  }} </ref> Diagnosis and treatment are etiology-dependent.
-**Inadequate doses
-**Inappropriate combinations
-**[[NSAIDs]], COX inhibitors
-**[[Cocaine]], [[amphetamines]], other illicit drugs
-**Sympathomimetics (decongestants, anorectics)
-**[[Oral contraceptive therapy]]
-**Adrenal steroid hormones
-**[[Cyclosporine]], [[tacrolimus]]
-**[[Erythropoietin]]
-**[[Licorice]] (including some chewing [[tobacco]])
-**Selected over the counter dietary supplements (like ephedra, ma huang, bitter orange)
-==Less Common Cuases==
+=====Endocrine=====
-* [[Acromegaly]]
+In addition to the more common endocrine causes of hypertension such as hyperaldosteronism, [[Cushing’s syndrome]], and [[pheochromocytoma]], several other endocrine changes can cause hypertension. Both hypothyroidism and hyperthyroidism can cause hypertension by volume retention and by increased cardiac output, respectively. Also, [[hyperparathyroidism]] and hypovitaminosis D can cause hypertension due to poorly understood mechanisms, where [[parathyroidectomy]] seems to significantly decrease blood pressure in patients with parathyroid disease and elevated BP.<ref name="pmid22145139">{{cite journal| author=Chopra S, Cherian D, Jacob JJ| title=The thyroid hormone, parathyroid hormone and vitamin D associated hypertension. | journal=Indian J Endocrinol Metab | year= 2011 | volume= 15 Suppl 4 | issue=  | pages= S354-60 | pmid=22145139 | doi=10.4103/2230-8210.86979 | pmc=PMC3230087 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22145139  }} </ref>  [[Acromegaly]] can also be a cause of hypertension.
-* [[Coarctation of the aorta]]
-* [[Hyperparathyroidism]]
-* [[Liquorice]] (black, not red). Drives up cortisol causing a Cushing-like syndrome.
-* [[Neurofibromatosis]]
-==Complete List of Causes by Organ System==
+==Causes by Organ System==
 {|style="width:80%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic regurgitation]], [[Aortic dissection]], [[Acute severe vascular damage]], [[Adams Nance syndrome ]], [[Aneurysm]], [[Aortic coarctation ]], [[Aortic stenosis]], [[Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly ]], [[Arteriosclerosis]], [[Atheroma]], [[Avasthey syndrome ]], [[Carotid paraganglioma ]],Congenital [[Mitral stenosis ]], [[Eisenmenger's Syndrome ]], [[Fibromuscular dysplasia of arteries ]], [[Grange syndrome ]], [[Hemangiomatosis]] - familial pulmonary capillary, [[Hypertensive heart disease ]], [[Pulmonary artery agenesis ]], [[Vasculitis ]], [[Patent ductus arteriosus]], [[Third degree AV block]]
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic regurgitation]], [[aortic dissection]], acute severe vascular damage, [[adams Nance syndrome ]], [[aneurysm]], [[aortic coarctation ]], [[aortic stenosis]], [[arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly ]], [[arteriosclerosis]], [[atheroma]], [[avasthey syndrome ]], [[carotid paraganglioma ]],Congenital [[mitral stenosis ]], [[eisenmenger's Syndrome ]], [[fibromuscular dysplasia of arteries ]], [[grange syndrome ]], hemangiomatosis (familial pulmonary capillary disease), [[hypertensive heart disease ]], [[pulmonary artery agenesis ]], [[vasculitis ]], [[patent ductus arteriosus]], [[third degree AV block]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Chemical / poisoning'''
-|bgcolor="Beige"| [[Acetaldehyde ]], [[Aristolochic acid]] poisoning , [[Arizona Bark Scorpion poisoning ]], [[Black widow spider envenomation ]], [[Cadmium poisoning]], [[Cocaine]] poisoning , [[Ecstasy]] abuse , [[Ginseng ]], [[Heavy metal poisoning]], Indian [[Tobacco]] poisoning, [[Jimsonweed poisoning ]], [[Lead]] poisoning , [[Lockwood-Feingold syndrome ]], [[Mustard tree poisoning ]], [[Nicotine]] addiction , [[Pseudoephedrine]] poisoning , [[Silicosis ]], [[Toxic mushrooms -- Psychedelic ]], [[Lobelia]] poisoning
+|bgcolor="Beige"| [[Acetaldehyde ]], [[aristolochic acid]] poisoning , [[arizona Bark Scorpion poisoning ]], [[black widow spider envenomation ]], [[cadmium poisoning]], [[cocaine]], [[ecstasy]] abuse , [[ginseng ]], [[heavy metal poisoning]], Indian [[tobacco]] poisoning, [[jimsonweed poisoning ]], [[lead poisoning]] , [[lockwood-Feingold syndrome ]], [[mustard tree poisoning ]], [[nicotine]] addiction , [[pseudoephedrine]] poisoning , [[silicosis ]], [[toxic mushrooms -- Psychedelic ]], [[lobelia]] poisoning
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 122: / Line 198: @@
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| [[Almotriptan]], [[Dihydroergotamine]], [[Ergotamine]], [[Frovatriptan]], [[Isometheptene]], [[Rizatriptan]], [[Sumatriptan]], [[Zolmitriptan]], [[Amitriptyline]], [[Cyclosporine]], [[Desipramine]], [[Doxepin]], [[Ephedrine]], [[Glucocorticoid resistance ]], [[Imipramine]], [[Nasal decongestants]], [[Nortriptyline]], [[Combined oral contraceptive pill]], [[Phencyclidine]], [[Phenylpropanolamine]], [[Protriptyline]], [[Sedative dependence]], [[Serotonin toxicity]], [[Steroid abuse]], [[Pseudoephedrine]]
+|bgcolor="Beige"| [[almotriptan]], [[amitriptyline]],  [[Asenapine maleate]], [[Atropine]], [[Beractant]], [[Betamethasone valerate]], [[Benzphetamine]], [[Betamethasone dipropionate]], [[Butorphanol]], [[Cidofovir]], [[cocaine]], [[combined oral contraceptive pill]], [[cyclosporine]], [[caspofungin acetate]], [[desipramine]], [[Desmopressin]], [[Desogestrel and Ethinyl Estradiol]], [[Diethylpropion]], [[dihydroergotamine]], [[diflunisal]], [[Dimercaprol]], [[Dipivefrine]], [[doxepin]], [[Drospirenone and Ethinyl estradiol]], [[Eculizumab]], [[Eletriptan]], [[ephedrine]], [[ergotamine]], [[Erythropoietin]], [[Estropipate]], [[etodolac]], [[febuxostat]], [[Florbetapir F-18]], [[formoterol]], [[frovatriptan]], [[gadoterate]], [[glucocorticoid resistance ]], [[gadopentetate]], [[Hydrocortisone]], [[Hydroxocobalamin]], [[Indomethacin]], [[imipramine]], [[interferon alfacon-1]], [[isometheptene]], [[Ketorolac tromethamine]], [[Lanreotide]], [[Leuprolide]], [[Levalbuterol]], [[Medroxyprogesterone]], [[Mefenamic acid]], [[Megestrol]], [[Meloxicam]],  [[Meloxicam]], [[Meropenem]], [[Metipranolol]], [[Methylene blue]], [[Methylphenidate]], [[Methylprednisolone]],  [[Metoclopramide]], [[Methoxy polyethylene glycol-epoetin beta]], [[Mifepristone]], [[Milnacipran hydrochloride]], [[Mirabegron]], [[monoamine oxidase inhibitor]]s, [[Nabilone]], [[Naphazoline]] , [[nasal decongestants]], [[Naproxen and esomeprazole magnesium]], [[Norethindrone acetate and Ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol]],  [[nortriptyline]], [[NSAIDs]], [[Oxaprozin]], [[Oxcarbazepine]], [[Pentamidine Isethionate]], [[Pergolide]], [[phencyclidine]], [[Phendimetrazine]], [[phenylpropanolamine]], [[Pilocarpine]], [[Piroxicam]], [[Pralidozxime]], [[protriptyline]], [[pseudoephedrine]], [[prednisolone]], [[Prednisone]], [[Ramucirumab]], [[Rasagiline]], [[Repaglinide and Metformin hydrochloride]],  [[rizatriptan]], [[Rotigotine]], [[sedative dependence]], [[serotonin toxicity]], [[Sertraline]], [[Sipuleucel-T]], [[Sorafenib]], [[steroid abuse]], [[Sulindac]], [[sumatriptan]], [[Sunitinib]], [[Thalidomide]], [[Tiagabine]], [[Tocilizumab]], [[Tolmetin]], [[Travoprost]], [[Triamcinolone]], [[Valganciclovir hydrochloride]], [[zolmitriptan]], [[Zolmitriptan]], [[Zonisamide]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 131: / Line 207: @@
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| [[Carcinoid Syndrome]], [[Acromegaly ]], [[Adrenal incidentaloma ]], [[Alcohol-induced pseudo-Cushing syndrome ]], [[Apparent mineralocorticoid excess ]], [[Congenital adrenal hyperplasia]] - 11-Beta-hydroxylase deficiency, [[Congenital adrenal hyperplasia]] - 17-alpha-hydroxylase deficiency, [[Conn's syndrome]], [[Cushing's disease]], [[Cushing's syndrome ]], [[Diabetes]], Familial  [[Cushing syndrome ]], [[Graves Disease ]], [[Hyperadrenalism ]], [[Hyperparathyroidism ]], [[Hyperpituitarism ]], [[Hyperthyroidism]], [[Hypothyroidism]],[[Isolated secretion of corticosterone]], [[Isolated secretion of deoxycorticosterone]], [[Mineralocorticoid excess]], [[Multiple endocrine neoplasia type 1]], [[Myxoedema]], [[Pheochromocytoma]], [[Primary aldosteronism]], [[Primary cortisol resistance]], [[Pseudohyperaldosteronism ]], [[Pseudohypoaldosteronism ]], [[Schroeder syndrome 1 ]], [[Hyperthyroidism]], [[Hypoglycemia]], [[Isolated secretion of 18-hydroxy-deoxycorticosterone]], [[Renin-secreting tumors]], [[Dexamethasone sensitive hypertension]]
+|bgcolor="Beige"| [[Carcinoid Syndrome]], [[acromegaly ]], [[adrenal incidentaloma ]], [[alcohol-induced pseudo-Cushing syndrome ]], [[apparent mineralocorticoid excess ]], [[congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]], [[congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]], [[Conn's syndrome]], [[cushing's disease]], [[cushing's syndrome ]], [[diabetes]], Familial  [[cushing syndrome ]], [[graves disease ]], [[hyperadrenalism ]], [[hyperparathyroidism ]], [[hyperpituitarism ]], [[hyperthyroidism]], [[hypothyroidism]], isolated secretion of corticosterone, isolated secretion of deoxycorticosterone, [[mineralocorticoid excess]], [[multiple endocrine neoplasia type 1]], [[myxoedema]], [[pheochromocytoma]], [[primary aldosteronism]], primary cortisol resistance, [[pseudohyperaldosteronism ]], [[pseudohypoaldosteronism ]], [[Schroeder syndrome 1 ]], [[hyperthyroidism]], [[hypoglycemia]], isolated secretion of 18-hydroxy-deoxycorticosterone, [[renin-secreting tumors]], [[dexamethasone sensitive hypertension]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 139: / Line 215: @@
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| [[Hepatorenal tyrosinemia ]], [[Pancreatitis]], [[Retroperitoneal Fibrosis]]
+|bgcolor="Beige"| [[Hepatorenal tyrosinemia ]], [[pancreatitis]], [[retroperitoneal Fibrosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"|  [[Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]], [[Congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]], [[Cockayne syndrome ]], [[Down Syndrome ]], [[Fabry's Disease ]], [[Isolated secretion of 18-hydroxy-deoxycorticosterone]], [[Pierre Robin's sequence ]], [[Senior-Loken Syndrome]], [[Turner Syndrome ]], [[Vater-like syndrome with pulmonary hypertension, abnormal ears and growth deficiency ]], [[Von Hippel-Lindau Disease ]], [[Werner syndrome ]], [[Williams Syndrome ]], [[Gaucher disease type 3 ]], [[Mucopolysaccharidosis]] type I [[Hurler syndrome ]]
+|bgcolor="Beige"|  [[Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]], [[congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]], [[cockayne syndrome ]], [[down Syndrome ]], [[Fabry's Disease ]], isolated secretion of 18-hydroxy-deoxycorticosterone, [[Pierre Robin's sequence ]], [[Senior-Loken Syndrome]], [[Turner Syndrome ]], [[Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency ]], [[Von Hippel-Lindau Disease ]], [[Werner syndrome ]], [[Williams Syndrome ]], [[Gaucher disease type 3 ]], [[mucopolysaccharidosis]] type I [[Hurler syndrome ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| Atypical [[Hemolytic uremic syndrome]], Catastrophic [[Antiphospholipid Syndrome ]], Essential mixed [[Cryoglobulinemia ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[Hemolytic uremic syndrome ]], [[Hypereosinophilic syndrome ]], [[Liddle's syndrome]], Multicentric [[Reticulohistiocytosis ]], [[Polycythemia ]], [[Thromboembolism ]], [[Thrombotic thrombocytopenic purpura]]
+|bgcolor="Beige"| [[Anemia]], Atypical [[Hemolytic uremic syndrome]], Catastrophic [[antiphospholipid syndrome ]], Essential mixed [[cryoglobulinemia ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[hemolytic uremic syndrome ]], [[hypereosinophilic syndrome ]], [[Liddle's syndrome]], Multicentric reticulohistiocytosis , [[polycythemia ]], [[thromboembolism ]], [[thrombotic thrombocytopenic purpura]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 155: / Line 231: @@
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| [[Poliomyelitis]], [[Meningitis]], [[Post streptococcal glomerulonephritis ]], [[Renal tuberculosis]], [[Nipah virus encephalitis ]]
+|bgcolor="Beige"| [[Poliomyelitis]], [[meningitis]], [[post streptococcal glomerulonephritis ]], [[renal tuberculosis]], [[nipah virus encephalitis ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal / Ortho'''
-|bgcolor="Beige"| [[Acrodynia ]], [[Allain Babin Demarquez syndrome ]], Familial [[Osteodysplasia]] - Anderson type, [[Paget's disease of bone ]], [[Grange syndrome ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[Oculo skeletal renal syndrome ]], [[Thieffry and Sorrell Dejerine syndrome ]]
+|bgcolor="Beige"| [[Acrodynia ]], [[Allain Babin Demarquez syndrome ]], [[familial osteodysplasia - Anderson type]], [[Paget's disease of bone ]], [[Grange syndrome ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[oculo skeletal renal syndrome ]], [[Thieffry and Sorrell Dejerine syndrome ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Neurologic'''
-|bgcolor="Beige"| [[Guillain-Barre Syndrome]], [[Autonomic dysreflexia syndrome ]], [[Binswanger's Disease ]], Brain stem [[encephalitis]], [[Central sleep apnea ]], [[Choroideremia -- hypopituitarism ]], [[Disequilibrium syndrome ]], [[Dysautonomia ]], [[Hereditary sensory and autonomic neuropathy 3 ]], [[Increased intracranial pressure]],  [[Neurofibromatosis syndrome Type II]] , [[Neurogenic hypertension ]], [[Nipah virus encephalitis ]], [[Obstructive sleep apnea ]], [[Sneddon Syndrome ]], [[Upper spinal cord lesions]], [[Wolfram's disease]], [[Meningitis]], [[Polyradiculitis]], [[Quadriplegia]], [[Adams Nance syndrome ]], [[Glycine encephalopathy]] - classical neonatal form, [[Pituitary Cancer ]], [[Fitzsimmons-Walson-Mellor syndrome ]]
+|bgcolor="Beige"| [[Guillain-Barre Syndrome]], [[autonomic dysreflexia syndrome ]], [[Binswanger's Disease ]], Brain stem [[encephalitis]], [[central sleep apnea ]], [[choroideremia -- hypopituitarism ]], [[disequilibrium syndrome ]], [[dysautonomia ]], [[hereditary sensory and autonomic neuropathy 3 ]], [[increased intracranial pressure]],  [[neurofibromatosis syndrome Type II]] , [[neurogenic hypertension ]], [[nipah virus encephalitis ]], [[obstructive sleep apnea ]], [[Sneddon Syndrome ]], [[upper spinal cord lesions]], [[Wolfram's disease]], [[meningitis]], [[polyradiculitis]], [[quadriplegia]], [[Adams Nance syndrome ]], [[glycine encephalopathy]] - classical neonatal form, [[pituitary Cancer ]], [[Fitzsimmons-Walson-Mellor syndrome ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Nutritional / Metabolic'''
-|bgcolor="Beige"| [[Abdominal obesity metabolic syndrome ]], [[Acute intermittent porphyria ]], [[Congenital hepatic porphyria ]], [[Gaucher disease]] type 3, [[Glycine encephalopathy]] - classical neonatal form, [[Glycine synthase deficiency ]], [[Gouty nephropathy]], [[Metabolic syndrome]], [[Tyrosinemia ]], [[Von Gierke disease]] IB, [[Increased salt intake]], [[Mucopolysaccharidosis]] type I [[Hurler syndrome]], [[Fabry's Disease ]], [[Vitamin D -- adverse effects]]
+|bgcolor="Beige"| [[Abdominal obesity metabolic syndrome ]], [[acute intermittent porphyria ]], [[congenital hepatic porphyria ]], [[Gaucher disease]] type 3, [[glycine encephalopathy]] - classical neonatal form, [[glycine synthase deficiency ]], [[gouty nephropathy]], [[liquorice]], [[metabolic syndrome]], [[tyrosinemia ]], [[Von Gierke disease]] IB, [[increased salt intake]], [[mucopolysaccharidosis]] type I [[Hurler syndrome]], [[Fabry's Disease ]], [[vitamin D -- adverse effects]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Obstetric/Gynecologic'''
-|bgcolor="Beige"| [[Eclampsia ]], [[Fowler-Christmas-Chapple syndrome ]], [[Gestational hypertension]], [[HELLP syndrome ]], [[Ovarian dysgenesis]], [[PCOS]], [[Pregnancy toxemia /hypertension ]], [[Twin-Twin Transfusion Syndrome]]
+|bgcolor="Beige"| [[Eclampsia ]], [[Fowler-Christmas-Chapple syndrome ]], [[gestational hypertension]], [[HELLP syndrome ]], [[ovarian dysgenesis]], [[PCOS]], [[pregnancy toxemia /hypertension ]], twin-twin transfusion syndrome
 |-
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| [[Endothelin]] producing tumor, [[Adrenal Cancer ]], Familial  [[Adrenal adenoma ]], [[Renal Cancer ]], [[Neuroblastoma ]]
+|bgcolor="Beige"| [[Endothelin]] producing tumor, [[adrenal Cancer ]], familial  [[adrenal adenoma ]], [[renal Cancer ]], [[neuroblastoma ]]
-[[Pituitary Cancer ]], [[Renin-secreting tumors]], [[Rhabdoid tumor ]], [[Wilms' tumor ]], [[Adrenal incidentaloma ]], Familial [[Renal cell carcinoma ]]
+[[pituitary Cancer ]], [[renin-secreting tumors]], [[rhabdoid tumor ]], [[Wilms' tumor ]], [[adrenal incidentaloma ]], familial [[renal cell carcinoma ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Opthalmologic'''
-|bgcolor="Beige"| [[Isolated  Ectopia lentis]], [[Oculo skeletal renal syndrome ]]
+|bgcolor="Beige"| Isolated  Ectopia lentis, [[oculo skeletal renal syndrome ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Overdose / Toxicity'''
-|bgcolor="Beige"| [[Amphetamine]] abuse, [[Almotriptan]], [[Dihydroergotamine]], [[Ergotamine]], [[Frovatriptan]], [[Isometheptene]], [[Rizatriptan]], [[Sumatriptan]], [[Zolmitriptan]], [[Amitriptyline]], [[Cyclosporine]], [[Desipramine]], [[Dexamethasone]] sensitive hypertension, [[Doxepin]], [[Ephedrine]], [[Glucocorticoid resistance ]], [[Imipramine]], [[Nasal decongestants]], [[Nortriptyline]], [[Combined oral contraceptive pill]], [[Phencyclidine]], [[Phenylpropanolamine]], [[Protriptyline]], [[Serotonin toxicity]], [[Steroid abuse]], [[Pseudoephedrine]]
+|bgcolor="Beige"| [[Amphetamine]] abuse, [[almotriptan]], [[dihydroergotamine]], [[ergotamine]], [[frovatriptan]], [[isometheptene]], [[rizatriptan]], [[sumatriptan]], [[zolmitriptan]], [[amitriptyline]], [[cyclosporine]], [[desipramine]], [[dexamethasone]] sensitive hypertension, [[doxepin]], [[ephedrine]], [[glucocorticoid resistance ]], [[imipramine]], [[nasal decongestants]], [[nortriptyline]], [[combined oral contraceptive pill]], [[phencyclidine]], [[phenylpropanolamine]], [[protriptyline]], [[serotonin toxicity]], [[steroid abuse]], [[pseudoephedrine]], [[cocaine]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 192: / Line 268: @@
 |-bgcolor="LightSteelBlue"
 | '''Pulmonary'''
-|bgcolor="Beige"| [[Asphyxia ]], [[Bronchopulmonary dysplasia]], [[COPD ]], [[Goodpasture syndrome ]], [[Pulmonary cystic lymphangiectasis ]], [[Pulmonary embolism ]], [[Pulmonary fibrosis]] /[[granuloma ]], [[Pulmonary veno-occlusive disease ]], [[Pulmonary Lymphangiomatosis]], [[Respiratory acidosis ]], [[Respiratory failure ]], [[Unilateral pulmonary agenesis ]], [[Hyperventilation]], [[Obstructive sleep apnea ]], [[Wegener's granulomatosis ]]
+|bgcolor="Beige"| [[Asphyxia ]], [[bronchopulmonary dysplasia]], [[COPD ]], [[Goodpasture syndrome ]], [[pulmonary cystic lymphangiectasis ]], [[pulmonary embolism ]], [[pulmonary fibrosis]] /[[granuloma ]], [[pulmonary veno-occlusive disease ]], pulmonary lymphangiomatosis, [[respiratory acidosis ]], [[respiratory failure ]], [[unilateral pulmonary agenesis ]], [[hyperventilation]], [[obstructive sleep apnea ]], [[Wegener's granulomatosis ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Renal / Electrolyte'''
-|bgcolor="Beige"| [[Bartter's Syndrome]], [[Dissection of the renal arteries]], [[Acid-Base Imbalance ]], [[Acute Renal Failure ]], [[Albuminuria ]], [[Analgesic nephropathy syndrome ]], Autosomal dominant [[Polycystic kidney disease ]], Autosomal Recessive [[Polycystic Kidney Disease ]], Bilateral [[Renal artery stenosis ]], [[Bright's Disease ]], [[Chronic kidney disease ]], [[Chronic pyelonephritis]], Congenital [[Membranous  glomerulonephritis]], [[Congenital stenosis of renal artery]], [[Congenital  Hydronephrosis ]], [[Diffuse mesangial sclerosis]], Familial [[Renal cell carcinoma ]], [[Fitzsimmons-Walson-Mellor syndrome ]], [[Glomerulonephritis ]], [[Hereditary nephritis]] (X-linked), [[Hypoplastic kidney]], [[IgA nephropathy ]], [[Kidney arteriovenous fistula ]], [[Kimmelstiel-Wilson disease]], [[Lupus nephritis ]], [[Nephrocalcinosis ]], [[Nephrosclerosis ]], [[Nephrosis -- deafness -- urinary tract -- digital malformation ]], [[Nephrotic syndrome ]], [[Oculo skeletal renal syndrome ]], [[Pierson syndrome ]], Severe infantile [[Polycystic kidneys]] with [[Tuberous sclerosis ]], [[Post streptococcal glomerulonephritis ]], [[Renal artery thrombosis]], [[Renal emboli]], [[Renal segmental hypoplasia-induced Hypertension ]], [[Renal tuberculosis]], [[Salcedo syndrome ]], [[Simple kidney cysts ]], [[Thieffry and Sorrell Dejerine syndrome ]], [[Urinary tract infections ]], [[Urinary tract obstruction]], [[Vesicoureteral reflux ]], [[Wegener's granulomatosis ]], [[Gitelman's Syndrome]], [[Hepatorenal tyrosinemia ]], Atypical [[Hemolytic uremic syndrome]], [[Gouty nephropathy]], [[Goodpasture syndrome ]]
+|bgcolor="Beige"| [[Bartter's Syndrome]], [[dissection of the renal arteries]], [[acid-base imbalance ]], [[acute renal failure ]], [[albuminuria ]], [[analgesic nephropathy syndrome ]], autosomal dominant [[polycystic kidney disease ]], autosomal recessive [[polycystic kidney disease ]], bilateral [[renal artery stenosis ]], [[Bright's Disease ]], [[chronic kidney disease ]], [[chronic pyelonephritis]], congenital [[membranous  glomerulonephritis]], [[congenital stenosis of renal artery]], congenital hydronephrosis, [[diffuse mesangial sclerosis]], familial [[renal cell carcinoma ]], [[Fitzsimmons-Walson-Mellor syndrome ]], [[glomerulonephritis ]], [[hereditary nephritis]] (X-linked), [[hypoplastic kidney]], [[IgA nephropathy ]], [[kidney arteriovenous fistula ]], [[Kimmelstiel-Wilson disease]], [[lupus nephritis ]], [[nephrocalcinosis ]], [[nephrosclerosis ]], [[nephrosis -- deafness -- urinary tract -- digital malformation ]], [[nephrotic syndrome ]], [[oculo skeletal renal syndrome ]], [[Pierson syndrome ]], Severe infantile [[polycystic kidneys]] with [[tuberous sclerosis ]], [[post streptococcal glomerulonephritis ]], [[renal artery thrombosis]], [[renal artery stenosis]], [[renal emboli]], [[renal segmental hypoplasia-induced Hypertension ]], [[renal tuberculosis]], [[Salcedo syndrome ]], [[simple kidney cysts ]], [[Thieffry and Sorrell Dejerine syndrome ]], [[urinary tract infections ]], [[urinary tract obstruction]], [[vesicoureteral reflux ]], [[Wegener's granulomatosis ]], [[Gitelman's Syndrome]], [[hepatorenal tyrosinemia ]], Atypical [[hemolytic uremic syndrome]], [[gouty nephropathy]], [[Goodpasture syndrome ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Rheum / Immune / Allergy'''
-|bgcolor="Beige"| [[Autoimmune Vasculitis ]], [[Systemic lupus erythematosus]], Diffuse [[Systemic sclerosis ]], [[Polyarteritis nodosa ]], , [[Takayasu arteritis ]]
+|bgcolor="Beige"| [[Autoimmune Vasculitis ]], [[systemic lupus erythematosus]], diffuse [[systemic sclerosis ]], [[polyarteritis nodosa ]], [[Takayasu arteritis ]]
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 |-bgcolor="LightSteelBlue"
@@ Line 208: / Line 284: @@
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| [[Electrical burns ]], [[Head injury]], [[Skull fracture ]]
+|bgcolor="Beige"| [[Electrical burns ]], [[head injury]], [[skull fracture ]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 220: / Line 296: @@
 |-bgcolor="LightSteelBlue"
 | '''Miscellaneous'''
-|bgcolor="Beige"| Acquired total [[Lipodystrophy ]], After [[Kidney transplantation]], [[Age]], [[Alcohol withdrawal]], [[Amyloidosis ]], [[Bone cement implantation syndrome ]], [[Brachydactyly with hypertension]], [[Carnevale-Canun-Mendoza syndrome ]], [[Codeine withdrawal ]], [[Collagen disease]], [[Essential hypertension]], [[Gram's syndrome ]], [[Hypothermia]], [[Irradiation]], [[Kashani-Strom-Utley syndrome ]], [[Lymphomatoid Granulomatosis ]], [[MSBD syndrome ]], [[Neuroleptic Malignant Syndrome ]], [[Obesity]], [[Physical inactivity ]], [[Selye syndrome ]], [[Serotonin Syndrome ]], [[Shaken Baby Syndrome ]], [[Stress-Induced Hypertension ]], [[Type A personality]], [[Wagener syndrome ]], [[Pain]], [[Post-exercise]], [[Transfusion of large blood volumes]], [[White coat hypertension]]
+|bgcolor="Beige"| Acquired total [[lipodystrophy ]], following [[kidney transplantation]], [[aging]], [[alcohol|alcohol intake]], [[alcohol withdrawal]], [[amyloidosis ]], bone cement implantation syndrome, [[brachydactyly with hypertension]], [[Carnevale-Canun-Mendoza syndrome ]], [[codeine withdrawal ]], [[collagen disease]], [[essential hypertension]], [[fever]], [[Gram's syndrome ]], [[hypothermia]], [[irradiation]], [[Kashani-Strom-Utley syndrome ]], [[lymphomatoid granulomatosis ]], [[MSBD syndrome ]], [[neuroleptic malignant syndrome ]], [[obesity]], [[physical inactivity ]], [[Selye syndrome ]], [[serotonin syndrome ]], [[shaken baby syndrome ]], [[stress-induced hypertension ]], [[type A personality]], [[Wagener syndrome ]], [[pain]], [[post-exercise]], [[transfusion of large blood volumes]], [[white coat hypertension]]
 |-
 |}
-===Causes in Alphabetical Order===
+==Causes in Alphabetical Order==
 {{MultiCol}}
 * [[Abdominal obesity metabolic syndrome ]]
@@ Line 241: / Line 316: @@
 * [[Adrenal incidentaloma ]]
 * After [[Kidney transplantation]]
-* [[Age]]
+* [[Kidney tumor]]
+* [[Aging]]
 * [[Albuminuria ]]
+* [[Alcohol]]
 * [[Alcohol withdrawal]]
 * [[Alcohol-induced pseudo-Cushing syndrome ]]
@@ Line 251: / Line 328: @@
 * [[Amyloidosis ]]
 * [[Analgesic nephropathy syndrome ]]
+* [[Anemia]]
 * [[Aneurysm]]
 * [[Anxiety]]
@@ Line 256: / Line 334: @@
 * [[Aortic regurgitation]]
 * [[Aortic stenosis]]
+* [[Valvular diseases|Aortic valve disease]]
 * [[Apparent mineralocorticoid excess ]]
 * [[Aristolochic Acid poisoning ]]
@@ Line 263: / Line 342: @@
 * [[Asphyxia ]]
 * [[Atheroma]]
+*[[Atropine]]
 * Atypical [[Hemolytic uremic syndrome]]
 * [[Autoimmune Vasculitis ]]
@@ Line 270: / Line 350: @@
 * [[Avasthey syndrome ]]
 * [[Bartter's Syndrome]]
+*[[Betamethasone valerate]]
+*[[Betamethasone dipropionate]]
 * Bilateral [[Renal artery stenosis ]]
 * [[Binswanger's Disease ]]
@@ Line 278: / Line 360: @@
 * [[Bright's Disease ]]
 * [[Bronchopulmonary dysplasia]]
+*[[Butorphanol]]
 * [[Cadmium poisoning]]
 * [[Carcinoid Syndrome]]
@@ Line 287: / Line 370: @@
 * [[Chronic kidney disease ]]
 * [[Chronic pyelonephritis]]
-* [[Cocaine]] poisoning
+*[[Cidofovir]]
+* [[Cocaine]]
 * [[Cockayne syndrome ]]
 * [[Codeine withdrawal ]]
@@ Line 304: / Line 388: @@
 * [[Cyclosporine]]
 * [[Desipramine]]
+*[[Desmopressin]]
+*[[Desogestrel and Ethinyl Estradiol]]
 * [[Dexamethasone sensitive hypertension]]
 * [[Diabetes]]
@@ Line 317: / Line 403: @@
 * [[Eclampsia ]]
 * [[Ecstasy]] abuse
+* [[Eculizumab]]
 {{ColBreak}}
 * [[Eisenmenger's Syndrome ]]
@@ Line 330: / Line 417: @@
 * Familial  [[Cushing syndrome ]]
 * [[Faye-Petersen-Ward-Carey syndrome ]]
+* [[Fever]]
 * [[Fibromuscular dysplasia]] of arteries
 * [[Fitzsimmons-Walson-Mellor syndrome ]]
@@ Line 352: / Line 440: @@
 * [[HELLP syndrome ]]
 * Familial [[Hemangiomatosis]] - pulmonary capillary
-* Familial [[Osteodysplasia]] - Anderson type
+* [[Familial Osteodysplasia - Anderson type]]
 * [[Hemolytic uremic syndrome ]]
 * [[Hepatorenal tyrosinemia ]]
 * [[Hereditary nephritis]] (X-linked)
 * [[Hereditary sensory and autonomic neuropathy 3 ]]
+*[[Hydroxocobalamin]]
 * [[Hyperadrenalism ]]
 * [[Hypereosinophilic syndrome ]]
@@ Line 373: / Line 462: @@
 * [[Increased salt intake]]
 * Indian [[Tobacco]] [[Poisoning ]]
+*[[Infliximab]]
 * [[Irradiation]]
 * [[Isolated secretion of 18-hydroxy-deoxycorticosterone]]
@@ Line 384: / Line 474: @@
 * [[Renal Cancer ]]
 * [[Kimmelstiel-Wilson disease]]
-* [[Lead]] poisoning
+* [[Lead poisoning]]
+* [[Liquorice]]
 * [[Liddle's syndrome]]
 * [[Lobelia]] poisoning
@@ Line 390: / Line 481: @@
 * [[Lupus nephritis ]]
 * [[Lymphomatoid granulomatosis ]]
+* [[Medroxyprogesterone]]
+* [[Meloxicam]]
 * [[Meningitis]]
+* [[Meropenem]]
 * [[Metabolic syndrome]]
+* [[Methylphenidate]]
+* [[Mifepristone]]
+* [Milnacipran hydrochloride]]
 * [[Mineralocorticoid excess]]
+* [[Monoamine oxidase inhibitor]]s
 * [[MSBD syndrome ]]
 * [[Mucopolysaccharidosis]] type I [[Hurler syndrome]]
-* Multicentric [[Reticulohistiocytosis ]]
+* Multicentric [[Reticulohistiocytosis]]
 * [[Multiple endocrine neoplasia type 1]]
 * [[Mustard tree poisoning ]]
@@ Line 410: / Line 508: @@
 * [[Nicotine addiction ]]
 * [[Nipah virus encephalitis ]]
+* [[Norgestrel and Ethinyl estradiol]]
 * [[Nortriptyline]]
+* [[NSAIDs]]
 * [[Obesity]]
 {{ColBreak}}
@@ Line 417: / Line 517: @@
 * [[Oral contraceptive pill]]
 * [[Ovarian dysgenesis]]
+*[[Oxaprozin]]
 * [[Paget's disease of bone ]]
 * [[Pain]]
 * [[Pancreatitis]]
 * [[Patent ductus arteriosus]]
+*[[Pergolide]]
 * [[PCOS]]
 * [[Pheochromocytoma]]
@@ Line 428: / Line 530: @@
 * [[Pierre Robin's sequence ]]
 * [[Pierson syndrome ]]
+*[[Pilocarpine]]
+* [[Piroxicam]]
 * [[Pituitary Cancer ]]
 * [[Poliomyelitis]]
@@ Line 436: / Line 540: @@
 * [[Post streptococcal glomerulonephritis ]]
 * [[Post-exercise]]
+*[[Pralidoxime]]
 * [[Pregnancy toxemia /hypertension ]]
 * [[Primary aldosteronism]]
@@ Line 450: / Line 555: @@
 * [[Pulmonary Lymphangiomatosis]]
 * [[Quadriplegia]]
+*[[Ramucirumab]]
 * [[Renal artery thrombosis]]
+* [[Renal artery stenosis]]
 * [[Renal emboli]]
 * [[Renal segmental hypoplasia-induced Hypertension ]]
@@ Line 471: / Line 578: @@
 * [[Silicosis ]]
 * [[Simple kidney cysts ]]
+*[[Sipuleucel-T]]
 * [[Skull fracture ]]
 * [[Sneddon Syndrome ]]
+*[[Sorafenib]]
 * [[Steroid abuse]]
 * [[Stress-induced hypertension ]]
 * [[Sumatriptan]]
+* [[Sunitinib]]
 * [[Systemic lupus erythematosus]]
 * [[Takayasu arteritis ]]
@@ Line 482: / Line 592: @@
 * [[Thromboembolism ]]
 * [[Thrombotic thrombocytopenic purpura]]
+*[[Tiagabine]]
 * [[Toxic mushrooms -- Psychedelic ]]
 * [[Transfusion of large blood volumes]]
@@ Line 492: / Line 603: @@
 * [[Urinary tract infections ]]
 * [[Urinary tract obstruction]]
+* [[Valganciclovir hydrochloride]]
 * [[Vasculitis ]]
 * [[Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency ]]