이차성 고혈압
Secondary Hypertension
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초록
이차성 고혈압의 유병률이 10% 내외로 알려져 있지만 저항성 고혈압의 흔한 원인이고, 진단 기술의 발달과 고령화로그 유병률은 증가 될 가능성이 있는 질환이다. 이차성 고혈압은 약물치료로 혈압이 잘 조절이 되지 않고, 초기부터 심혈관계 합병증이 동반된 경우가 많으며, 적절한 원인적 치료를 하지 않은 경우 치명적인 경우도 발생할 수 있을 뿐 아니라, 적절한 치료로 혈압이 치료될 수도 있다. 이차성 고혈압의 흔한 원인으로는 만성 콩팥병, 신혈관 고혈압(신동맥 협착증), 수면무호흡증, 일차성 알도스테론증이 있고, 드문 원인이지만 원인 질환 치료시 완치가 가능한 갈색 세포증, 쿠싱 증후군, 부갑상선 기능 항진증, 갑상선 질환 등이 있다. 임상적으로 고혈압가족력이 없고 비만하지 않는 20세 이하 혹은 50세 이후에 고혈압이 갑작스레 발생한 경우, 발생 초기부터 심한 고혈압을보인 경우, 발생 초기부터 고혈압의 심한 합병증을 보이는 경우, 저칼륨 혈증이나 고칼슘 혈증을 보인 경우, ACEi나 ARC를복용한 후 급작스런 신기능이 악화된 경우, 혈압의 변동이 심한 경우, 몸통 비만과 달덩이 얼굴, 낮에 졸림이 많고 코골이가심한 경우 등이 있는 경우는 이차성 고혈압을 의심해야 한다. 자세한 문진과 정확한 진찰, 세밀한 검사 결과의 해석은 이차성 고혈압의 원인을 찾는 데 도움을 줄 것이다. 이차성 고혈압의 원인 질환에 대한 임상적 특징과 진단적 접근, 치료에 대해정리하였다.
Abstract
Hypertension is a major risk factor for the development of cardiovascular disease. The prevalence of secondary hypertension, 10% is known as a common cause of resistant hypertension. Development of diagnostic technology and the aging is likely to be increased of the prevalence. Secondary hypertension, if it is not appropriate etiologic treatment may sometimes be fatal, as well as to the proper treatment be treatable or curable hypertension. Secondary causes of hypertension include a greater prevalence of obstructive sleep apnea, renal parenchymal disease, renovascular disease and primary aldosteronism. Uncommon secondary causes include pheochromocytoma, Cushing's syndrome,hyperparathyroidism and thyroid disease. Clinical clues for secondary hypertension is onset of hypertension in persons younger than age 20 or older than age 50 without family history of hypertension, poor response to therapy, worsening of control in previously stable hypertensive patient, markedly elevated blood pressure or hypertension with severe endorgan damage, presence of abdominal bruit (renal artery stenosis), moon face and abdominal striae (Cushing's syndrome),paroxysmal headaches and palpitations (pheochromocytoma), pronounced hypokalemia due to low dose diuretic therapy (primary aldosteronism), acute renal failure or hypokalemia after initiation of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker (renal artery stenosis), hypercalcemia (hyperparathyroidism), snoring and daytime somnolence (obstructive sleep apnea). A combination of a good history and physical examination, astute observation, and accurate interpretation of available data usually are helpful in the diagnosis of a specific causation. This article provides an overview of the range of secondary hypertension, including key clinical features, appropriate diagnostic approach and treatment for primary physician.
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