Essential hypertension? Secondary hypertension? What's the difference? 3 very big differences

Patients with high blood pressure often ask me in the outpatient clinic, "Dr. Zhang, why is high blood pressure divided into primary and secondary types? What is the difference between them? Don't they all take medicine?" ”

This is wrong! Although they are both high blood pressure, they are very different.

Although essential hypertension and secondary hypertension both present elevated blood pressure, their diagnosis and treatment methods are completely different. When encountering some secondary hypertension, if you take antihypertensive drugs without a clear diagnosis, it may even aggravate the condition and lead to serious adverse reactions such as renal failure or even shock.

Next, let’s talk about the difference between “essential hypertension” and “secondary hypertension” from three aspects.

In layman's terms, high blood pressure that can identify the cause of elevated blood pressure is secondary hypertension. On the other hand, those who cannot find a clear cause of the increase in blood pressure are called essential hypertension.

There are many diseases, such as certain renal and kidney diseases, renal vascular stenosis, endocrine abnormalities or sleep apnea syndrome, etc., which can cause high blood pressure. Like this kind of high blood pressure caused by other diseases, We collectively call it "secondary hypertension".

However, there is often no clear pre-existing disease for essential hypertension. We often consider it to be caused by certain congenital genes, bad living habits or mental stress. For example, high-sodium diet, alcoholism, obesity, high work pressure, staying up late, etc.

It is currently believed that secondary hypertension accounts for 5 to 10% of the total population with hypertension. However, with the continuous advancement of medical development and examination methods, the proportion of secondary hypertension will continue to increase, and the proportion of primary hypertension will continue to decrease. To put it bluntly, if there is a breakthrough in a certain examination technology and the cause of hypertension is essentially solved, it is not impossible that secondary hypertension will account for the vast majority.

Regardless of primary hypertension or secondary hypertension, secondary hypertension screening must be performed first, and secondary factors must be eliminated before treatment can be carried out. This is why many patients with high blood pressure undergo “a lot” of examinations even though they only adjust their antihypertensive drugs. It is no exaggeration to say that "checking" for high blood pressure is more important than "treating" it!

The treatment of essential hypertension is, in principle, to improve living habits combined with medication to lower blood pressure, and to regularly monitor blood pressure levels before adjusting medication.

Although the treatment of secondary hypertension also requires medication to lower blood pressure, priority should be given to treating the primary disease. Because the primary disease is not removed, it is difficult to effectively control blood pressure. For example, secondary hypertension caused by pheochromocytoma or renal vascular stenosis may require surgical treatment.

Risks such as essential hypertension mainly come from various complications caused by elevated blood pressure, such as cardiovascular and cerebrovascular stenosis, cerebral hemorrhage, etc. Often if blood pressure is well controlled, the risk of complications will be greatly reduced.

However, secondary hypertension is different. In addition to complications caused by elevated blood pressure, the risk mainly comes from secondary causes. Even taking antihypertensive drugs indiscriminately can cause serious complications, threatening life and health. For example, for secondary hypertension caused by renal blood vessel stenosis, if ACEI/ARB antihypertensive drugs are taken orally, not only will the blood pressure not be controlled, it will even seriously damage kidney function! In addition, pheochromocytoma can cause "dramatic" blood pressure fluctuations, high and low. If you only know how to take antihypertensive drugs, severe hypotension will often cause discomfort or even shock.

Many patients with high blood pressure come to the hospital for medical treatment and often "disagree" with the various examinations recommended by doctors. However, these examinations are crucial to the diagnosis and treatment of hypertension. Everyone must follow the doctor's advice!