SECONDARY HYPERTENSION

Transcription

1 SECONDARY HYPERTENSION

2 CLINICAL HYPERTENSION AND VASCULAR DISEASES WILLIAM B. WHITE, MD SERIES EDITOR Secondary Hypertension: Clinical Presentation, Diagnosis, and Treatment, edited by George A. Mansoor, MD, 2004 Pediatric Hypertension, edited by Ronald J. Portman, MD, Jonathan M. Sorof, MD, and Julie R. Ingelfinger, MD, 2004

3 SECONDARY HYPERTENSION Clinical Presentation, Diagnosis, and Treatment Edited by GEORGE A. MANSOOR, MD, FRCP (EDIN) Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, Farmington, CT SPRINGER SCIENCE+ BUSINESS MEDIA, LLC

4 2004 Springer Science+ Business Media New York Originally published by Hnmana Press Inc. in 2004 Softcover reprint of the hardcover 1st edition 2004 All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying. microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Production Editor: Robin B. Weisberg. Cover Illustration: (Foreground) From Chapter 13, "Biochemical Diagnosis and Localization of Pheochromocytoma," by Emmanuel L. Bravo. (Background) From Chapter 4, "Diagnostic Evaluation for Patients With Renovascular Hypertension," by Sumeska Thavarajah and William B. White. Cover design by Patricia F. Cleary. This publication is printed on acid-free ANSI Z (American N a tiona! Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Springer Science+ Business Media, LLC. provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Springer Science+ Business Media, LLC. The fee code for users of the Transactional Reporting Service is: [ /04 $25.00]. ISBN ISBN (ebook) DOI / Library of Congress Cataloging-in-Publication Data Secondary hypertension : clinical presentation, diagnosis, and treatment I edited by George A. Mansoor. p. ; em. -- (Clinical hypertension and vascular diseases) Includes bibliographical references and index. 1. Hypertension. [DNLM: 1. Hypertension--etiology. 2. Hypertension--diagnosis. 3. Hypertension--therapy. WG 340 S ] I. Mansoor, George A. II. Series. RC685.H8S '32--dc I

5 SERIES EDITOR's INTRODUCTION Secondary forms of hypertension are not uncommon in clinical practice, but they are often overlooked or forgotten by clinicians in many fields of medicine. Dr. George Mansoor' s volume on Secondary Hypertension is an important contribution to the field of clinical hypertension and vascular diseases, since it brings up to date the numerous diagnostic and therapeutic advances in the evaluation for secondary types of hypertension. In the past, textbooks usually stated that an etiology could be determined in less than 5% of patients presenting with newly diagnosed hypertension. We now know this is far too low a proportion (e.g., primary hyperaldosteronism alone may account for hypertension in 5% of patients presenting with chronic elevations in blood pressure). Secondary Hypertension has been thoughtfully organized into chapters evaluating screening and diagnosis, as well as medical and/or surgical intervention of the well-known etiologies of secondary hypertension in adults and children. Additional coverage is given to such exogenous or lesser appreciated causes of secondary hypertension as obstructive sleep apnea and drugs. These sections make this book novel because in the past little attention has been paid to the effects of noncardiac drugs that interfere with antihypertensive therapy or to exogenous substances that might induce refractory hypertension. As series editor of Clinical Hypertension and Vascular Diseases, I was delighted to learn of the superb authors recruited by Dr. Mansoor during the development of this volume. Each chapter has been written by an authority in his or her field. Secondary Hypertension will be of great value to all students and physicians interested in hypertension research, education, and practice for the years to come. William B. White, MD Professor of Medicine University of Connecticut School of Medicine, Farmington, CT v

6 PREFACE Secondary Hypertension: Clinical Presentation, Diagnosis, and Treatment reviews the essential clinical, diagnostic, and treatment aspects of secondary hypertension. The need for such a book is great as knowledge in this field has progressed rapidly and new and unique forms of secondary hypertension are being described on a regular basis. However, such traditional disorders as renal artery stenosis, aldosteronism, and pheochromocytoma have remained major considerations when secondary hypertension is suspected and still occupy a significant part of our time as specialists in hypertension. The discovery of secondary hypertension is important; it provides a potential cure for the patient, but at other times provides physiological information on which the clinician can base drug therapy. This book, therefore, covers in detail the forms of secondary hypertension likely to be considered in persons with suggestive clinical features or resistant hypertension. Our knowledge regarding most forms of secondary hypertension has grown significantly and our conventional impressions of some of these have certainly changed. The availability of magnetic resonance imaging has helped us in the evaluation of coarctation of the aorta and renal artery stenosis. Reliable biochemical tests allow us to screen relatively easily for a variety of endocrine causes of hypertension. In terms of treatment, we have a vast array of drugs available to treat hypertension, but also interventional therapy directed at the form of secondary hypertension, e.g., surgery or anti-aldosterone drugs. Finally, it is becoming clear that some disorders contribute more often to hypertension than previously believed; this is the case with obstructive sleep apnea and possibly primary aldosteronism. There is a need for a book collating and updating knowledge in this area; the causes and management of secondary hypertension span several traditional disciplines, including internal medicine, nephrology, cardiovascular medicine, endocrinology, and pulmonology. Each chapter gives a concise approach to its topic and therefore can be read on its own. Chapter 1 discusses the most common reason that an evaluation for secondary hypertension is performed: refractory hypertension. With today's lower goals for blood pressure, we may need to re-examine how we define refractory hypertension. In Chapter 2, Dr. Ehud Grossman and Dr. Franz Messerli consider the exogenous causes of hypertension. They Vll

7 Vlll Preface review old and new culprit substances that raise blood pressure and discuss possible mechanisms for their undesirable actions. Part II reviews renal disease and secondary hypertension. In Chapter 3, Dr. Robert Toto tackles the area of renal disease and hypertension. Hypertension is almost universally found in the presence of renal disease and may have a role in the progression of intrinsic renal disorders. Dr. Toto reviews current approaches to evaluating and managing hypertension in this setting. Dr. Sumeska Thavarajah and Dr. William White (Chapter 4) provide a comprehensive account of diagnostic strategies for renovascular hypertension and renal artery stenosis. Chapter 5 is devoted to the role of interventional therapies such as balloon angioplasty and stenting in the management of renovascular hypertension. In Chapter 6, Dr. Vincent Canzanello reviews important information regarding the medical treatment of renovascular hypertension and emphasizes that the majority of patients can be controlled medically. A debate continues in the literature about the relative merits of medical vs interventional treatments for renovascular hypertension. Finally, secondary hypertension caused by excessive renin production, as in renin-producing tumors, is reviewed by Dr. Timothy Reudelhuber in Chapter 7. Part III covers adrenal medullary and cortical causes of secondary hypertension. Dr. William Young (Chapter 8) reviews expertly the diagnostic strategy for primary aldosteronism, and Dr. Emmanuel Bravo (Chapter 9) reviews the treatment aspects of primary aldosteronism. They emphasize the advantages of ambulatory screening of hypertensive patients without hypokalemia as well as the fact that most patients with bilateral adrenal hyperplasia can enjoy excellent blood pressure control with medical treatment. The laparoscopic surgical removal of aldosteronomas is detailed by Dr. Mihir Desai and Dr. Inderbir Gill (Chapter 10) so as to make it understandable to both physicians and surgeons. In Chapter 11, Dr. William Kendrick, Dr. Jean-Michel Achard, and Dr. David Warnock then review the other forms oflow-renin hypertension, including monogenic forms. They emphasize the fact that all these disorders cause hypertension through sodium retention. The last chapter in this section, by Dr. Judith Whitworth, Dr. George Mangos, and Dr. John Kelly (Chapter 12), reviews the mechanisms, clinical evaluation, and treatment of hypertension from Cushing's syndrome, resulting from a variety of pathological entities. Part IV on adrenal medulla and hypertension is given detailed consideration because pheochromocytoma can be a malignant condition. This section not only considers pheochromocytoma, but other disorders mimicking it. In Chapter 13, Dr. Emmanuel Bravo leads the reader through

8 Preface ix a superlative account of when to suspect and how to screen for pheochromocytoma. Dr. Carl Malchoff, Dr. Dougald MacGillivray, and Dr. Steven Shichman (Chapter 14) review the current management of pheochromocytoma, including preoperative management and care of advanced cases. In Chapter 15, Dr. Otto Kuchel reviews a number of conditions that may mimic pheochromocytoma, so-called pseudo-pheochromocytoma, and also reviews the differentiating features of these disorders. In their chapter, Dr. Empar Lurbe and Dr. Joseph Redon (Chapter 16) provide an excellent review of secondary hypertension in children and adolescents. Obviously, the younger a child with hypertension is, the more likely that a secondary form of hypertension will be discovered. Finally, Chapter 17 by Dr. Thomas Pickering and Dr. Mona Yacoub reviews the normal hemodynamic and other changes during sleep, considers the relationship of sleep apnea to hypertension and its complications, and brings us up to date on its clinical features, diagnosis, and treatment. We have invited contributors who are easily recognizable as leaders in the field of hypertension. They have worked hard to expertly and concisely review traditional and established causes of secondary hypertension as well as new and less well known ones. Each chapter merits multiple reads and can act as a starting point for anyone seeking an upto-date, scientifically accurate review of a particular area in secondary hypertension. Of course, we are grateful to the authors who have worked hard on this book and provided us with excellent work. Special thanks to Diane Webster from the editorial office of Blood Pressure Monitoring at the University of Connecticut Health Center for helping with chapter preparation. We also thank Paul Dolgert at Humana Press for recognizing the importance of this book and the need for it. We hope you find Secondary Hypertension: Clinical Presentation, Diagnosis, and Treatment enjoyable and scientifically current. George A. Mansoor, MD, FRCP (EDIN)

9 CONTENTS Series Editor's Introduction... v Preface... vii Contributors... xiii part I. INTRODUCTION Refractory Hypertension... 3 George A. Mansoor 2 Iatrogenic and Drug-Induced Hypertension Ehud Grossman and Franz H. Messerli PART II. RENAL DISEASE AND SECONDARY HYPERTENSION 3 Hypertension in Chronic Kidney Disease Robert D. Toto 4 Diagnostic Evaluation for Patients With Renovascular Hypertension Sumeska Thavarajah and William B. White 5 Interventional Treatments for Renal Artery Stenosis George A. Mansoor 6 Medical Management of Renovascular Hypertension Vincent]. Canzanello 7 Primary Reninism or Renin-Secreting Tumors Timothy L. Reudelhuber PART III. ADRENAL CoRTEX AND HYPERTENSION 8 Primary Aldosteronism: Diagnosis William F. Young, Jr. 9 Medical Management of Primary Aldosteronism Emmanuel L. Bravo 10 Primary Aldosteronism: Surgical Approaches Mihir M. Desai and Inderbir S. Gill Xl

10 xu Contents 11 Nonprimary Aldosteronism: Mineralocorticoid Disorders William T. Kendrick, Jean-Michel Achard, and David G. Warnock 12 Hypertension in Cushing's Syndrome Judith A. Whitworth, George J. Mangos, and John J. Kelly PART IV. ADRENAL MEDULLA AND HYPERTENSION 13 Biochemical Diagnosis and Localization of Pheochromocytoma Emmanuel L. Bravo 14 Pheochromocytoma Treatment Carl D. Malchofj, Dougald MacGillivray, and Steven Shichman 15 New Insights into Pseudopheochromocytoma and Emotionally Provoked Hypertension Otto Kuchel PART V. CHILDREN AND SECONDARY HYPERTENSION 16 Secondary Hypertension in Children and Adolescents Empar Lurbe and Josep Redon PART VI. SLEEP APNEA AND HYPERTENSION 17 Sleep Apnea and Hypertension Thomas G. Pickering and Mona Yacoub Index

11 CONTRIBUTORS JEAN-MICHEL AcHARD, MD, PhD Department of Physiology, University Hospital, Limoges, France EMMANUEL L. BRAVO, MD Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Cleveland, OH VINCENT J. CANZANELLO, MD Division of Hypertension and Internal Medicine and Division of Nephrology and Internal Medicine, Mayo Clinic and Mayo Medical School, Rochester, MN MIHIR M. DESAI, MD Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH INDERBIR S. GILL, MD Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH EHUD GROSSMAN, MD Department of Internal Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, Israel WILLIAM T. KENDRICK, MD Departments of Medicine and Physiology & Biophysics, and Nephrology Research and Training Center, University of Alabama at Birmingham, Birmingham, AL JoHN J. KELLY, MD Departments of Medicine and Renal Medicine, St. George Hospital, The University of New South Wales, Kogarah, Australia Orro KucHEL, MD, DSc University of Montreal and Clinical Research Institute of Montreal, Montreal, Quebec, Canada EMPAR LuRBE, MD Pediatric Nephrology Unit, Hospital General, University of Valencia, Valencia, Spain CARL D. MALCHOFF, MD, PhD Department of Medicine, University of Connecticut Health Center, Farmington, CT DouGALD MAcGILLIVRAY, MD University of Vermont Department of Surgery at Maine Medical Center, Portland, ME GEORGE J. MANGOS, MD Departments of Medicine and Renal Medicine, St. George Hospital, The University of New South Wales, Kogarah, Australia GEORGE A. MANSOOR, MD, FRCP (EDIN) Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, Farmington, CT FRANZ H. MESSERLI, MD Ochsner Clinic Foundation, New Orleans, LA Xlll

12 XIV Contributors THOMAS G. PICKERING, MD, DPHIL Behavioral Cardiovascular Health and Hypertension Program, Columbia Presbyterian Hospital, New York, NY JosEP REDON, MD Hypertension Clinic, Internal Medicine, Hospital Clinic, University of Valencia, Valencia, Spain TIMOTHY L. REUDELHUBER, PhD Laboratory of Molecular Biochemistry of Hypertension, Clinical Research Institute of Montreal, Montreal, Quebec, Canada STEVEN SHICHMAN, MD Department of Urology, Hartford Hospital, Hartford, CT and Department of Urology, University of Connecticut Health Center, Farmington, CT SuMESKA THAVARAJAH, MD Section of Hypertension and Clinical Pharmacology, University of Connecticut Health Center, Farmington, CT RoBERT D. ToTo, MD Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX DAVID G. WARNOCK, MD Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL WILLIAM B. WHITE, MD Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, Farmington, CT JuDITH A. WHITWORTH, MD, PhD John Curtin School of Medical Research, The Australian National University, Canberra, Australia MoNA YACOUB, MD Division of General Medicine, Columbia Presbyterian Hospital, New York, NY WILLIAM F. YouNG, JR., MD Division of Endocrinology and Metabolism, Mayo Clinic and Medical School, Rochester, MN