Endocrine Hypertension: Common yet under reported cause of Hypertension

Hypertension affects around 25% of the population worldwide this every 1 in 4 adults have hypertension. Hypertension is common and we all see many of our family members, relatives and friends taking medications for this and some of them suffer drastically. Mostly we don’t care about the severity, forget about the cause. All we do is the occasional visit to our physician and blood pressure recordings at the clinic.

Out of the most common cause of hypertension called ‘benign’ or ‘essential hypertension’ there are many patients with Endocrine hypertension’ who are treatable or sometimes curable but mostly they are missed. Moreover, the endocrine causes of hypertension may have catastrophic outcomes like stroke, myocardial infarction or heart attack and even heart failure. I have seen a case who had hypertension as high as 250/130 mm Hg for greater than 20 years and not responding to four or five medications. Finally, an adrenal tumor (tumor in a small gland above the kidney) was picked up on routine ultrasound and later that patient was diagnosed as a case of ‘Pheochromocytoma’ which is a catecholamine (a stress hormone) secreting tumor. After surgery, the patient was absolutely normal with normal blood pressure without medications and no more palpitations, headache or dizziness which were part and parcel of his life for the last 20 years. This story highlights the fact that a proper screening for such causes of hypertension may save many lives and unnecessary adverse events.

Who are the patients to look for endocrine hypertension?

Generally, patients with young-onset hypertension especially less than 30 years, resistant hypertension (requiring 3 or more blood pressure medications), having a strong family history of hypertension or having special features like palpitations, excessive sweating, loss of consciousness or sometimes extreme weakness of hands and limbs due to low potassium are the ones who need additional testing.

What are the causes of endocrine hypertension?

There are many causes but common are primary Aldosteronism (a tumor that secretes hypertension causing hormone ‘aldosterone’) may cause hypertension in as many as 15% of patients with young-onset hypertension and thus it must be ruled out. Interestingly, it is associated with increased adverse cardiac events. The other common causes are pheochromocytoma, hyperthyroidism. Rarely pituitary tumours like Cushing’s disease or Acromegaly may present with severe hypertension.

What is the benefit of finding endocrine hypertension?

Appropriate treatment can cure the disease thus alleviating the need for medications and prevention of damage caused by chronic hypertension are prime benefits. Moreover, some of these causes are genetic and run-in families and hence an added genetic test may help in finding the disease in other family members and also gives an opportunity for genetic counselling as well.

What is the general advice for hypertension?

Whatever is the cause of hypertension patients should take their medications regularly. Except few conditions all are advised to restrict salt intake so avoid pickles and extra salt in your food. Quitting alcohol and smoking, reduction of weight, avoidance of stress and plenty of fruits and vegetables in diet are measures to curb hypertension to some extent. Sometimes, common food items like ginseng or liquorice can cause hypertension and thus should be avoided.

Dr. Shivendra Verma | Consultant – Endocrinology | NH MMI Narayana Superspeciality Hospital, Raipur