High Blood Pressure (Arterial Hypertension): Or something else? Differential Diagnosis

Primary (essential) hypertension [cause: circa 91%]

Secondary hypertension:

Note: Arterial hypertension may have up to 10% endocrine causes. Younger and refractory patients should therefore also be evaluated for endocrine causes of hypertension. Blood, hematopoietic organs-immune system (D50-D90).

  • Antiphospholipid syndrome (APS; antiphospholipid antibody syndrome) – autoimmune disease; predominantly affects women (gynecotropia); characterized by the following triad:

Endocrine, nutritional, and metabolic disorders (E00-E90).

  • Acromegaly – endocrinologic disorder caused by overproduction of growth hormone (somatotropic hormone (STH), somatotropin), with marked enlargement of the body end limbs or protruding parts of the body (acras), such as the hands, feet, lower jaw, chin, nose, and eyebrow ridges.
  • Conn syndrome (primary hyperaldosteronism, PH).
    • In its classic (hypokalemic) form, belongs to the rarer causes of hypertension, with a frequency of 0.5-1%; however, up to 10% of patients with hypertension have normokalemic (normal potassium) hyperaldosteronism
    • Overall prevalence (disease incidence) of PA increased with severity of hypertension, from 3.9% in stage I to 11.8% in stage III hypertension
  • Cushing’s syndrome (Cushing’s disease; hypercortisolism) – renal cortical hyperfunction with elevated cortisol levels [cause: approximately 0.3%].
  • Hyperthyroidism (hyperthyroidism).
  • Myxedema – pasty (puffy; bloated) skin showing non-push-in, doughy edema (swelling) that is not positional; on the face and peripherally; especially on the lower legs; occurring primarily in the setting of hypothyroidism (underactive thyroid)

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99).

  • Aortic isthmic stenosis (ISTA; synonym: coarctation of the aorta: coarctatio aortae) – narrowing of the aorta (the aorta of the body) in the region of the aortic arch.
  • Aortic valve insufficiency – defective closure of the aortic valve of the heart.
  • Atherosclerosis (arteriosclerosis, hardening of the arteries).
  • Cholesterol embolism syndrome – occlusion of small arteries by wash-in (embolism) of cholesterol crystals from broken (ulcerated) arteriosclerotic plaques.
  • Renal artery stenosis – narrowing of the renal artery.
  • Renal infarction – kidney damage due to circulatory problems.
  • Primary idiopathic hypertension – hypertension in which no cause could be found.

Infectious and parasitic diseases (A00-B99).

  • Parasitoses (parasite infestations), unspecified.

Musculoskeletal system and connective tissue (M00-M99).

Neoplasms – tumor diseases (C00-D48).

  • Carcinoid tumor (synonyms: Carcinoid syndrome, neuroendocrine tumors, NET) – tumors originating in the neuroendocrine system; they are predominantly located in the appendix/appendix appendix (appendiceal carcinoid) or bronchi (bronchial carcinoid); other localizations include the thymus (thymic carcinoid), ileum/ruminal intestine (ileal carcinoid), rectum/foregut (rectal carcinoid), duodenum/duodenal intestine (duodenal carcinoid), and stomach (gastric carcinoid); typical symptoms are characterized by the triad of diarrhea (diarrhea), flushing (facial flushing), and Hedinger syndrome (endocardial fibrosis of the right heart, which can lead to tricuspid regurgitation (leakage with backflow of blood from the heart valve between the right atrium and the right ventricle) and pulmonary stenosis (narrowing in the outflow tract from the right ventricle to the pulmonary artery).
  • Pheochromocytoma – mostly benign (benign) tumor (about 90% of cases), which originates mainly from the adrenal gland and can lead to hypertension crises (hypertensive crisis) [cause: circa 0.3%].
  • Polycythaemia vera – pathological multiplication of blood cells (particularly affected are: especially erythrocytes / red blood cells, to a lesser extent also platelets (blood platelets) and leukocytes / white blood cells); stinging itch after contact with water (aquagenic pruritus).
  • Renin-producing tumors

Psyche – nervous system (F00-F99; G00-G99)

  • Increased intracranial pressure
    • Encephalitis (inflammation of the brain)
    • Guillain-Barré syndrome (GBS; synonyms: Idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two courses: acute inflammatory demyelinating polyneuropathy or chronic inflammatory demyelinating polyneuropathy (disease of the peripheral nervous system); idiopathic polyneuritis (diseases of multiple nerves) of spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infections.
    • Brain tumor
    • Idiopathic intracranial hypertension (IIH; synonym: pseudotumor cerebri, PTC) – increased intracranial pressure without explanatory cause; 90% of patients suffer from headaches, these usually increase when bending forward, coughing or sneezing; in every second patient is a papilledema (swelling (edema) at the junction of the optic nerve in the retina, which is noticeable as a protrusion of the optic nerve head; congestion papilla i. R. bilateral); occurrence with bilateral ocular symptomatology [sudden loss of vision in child].
    • Meningitis (meningitis)
    • Traumatic brain injury (TBI)
    • Tetraplegia (paraplegia in which all four limbs, i.e., both legs and arms, are affected)
  • Polyneuropathy – disease of the peripheral nervous system with disturbances of sensitivity (insensitivity, etc.).
  • Sleep apnea syndrome (Obstructive sleep apnea syndrome; Central sleep apnea syndrome) – symptom caused by respiratory arrest (apnea) during sleep.

Pregnancy, childbirth and puerperium (O00-O99).

  • Pregnancy toxicemia – pregnancy poisoning (pregnancy hypertension)EPH gestosis – pregnancy-associated triad of symptoms of edema (edema), protein excretion in the urine (proteinuria), and hypertension (hypertension).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99) [renal causes: about 5%].

  • Analgesic nephropathy – kidney damage after overdose of analgesics.
  • Chronic pyelonephritis – inflammation of the renal pelvis.
  • Diabetic nephropathy – kidney disease due to vascular disease in the presence of diabetes mellitus (diabetes).
  • Glomerulonephritis – kidney disease associated with inflammation of the renal corpuscles (glomerulum, plural glomeruli or glomerula, corpuscula renales) in the kidney.
  • Interstitial nephritis (kidney disease).
  • Renal involvement of systemic diseases
  • Reflux nephropathy – disease of the kidneys due to reflux (backflow) of urine into the upper urinary tract.
  • Cystic kidney disease (synonym: polycystic kidney disease) – hereditary disease characterized by the gradual formation of a large number of cysts within the kidneys.

Injuries, poisonings and other consequences of external causes (S00-T98).

Medication

  • See “Cause” under medications

Environmental pollution – intoxications (poisoning).

  • Lead
  • Cadmium
  • Carbon monoxide
  • Thallium