KenDBerryMD - Hidden High Blood Pressure Causes [Secondary Hypertension causes]

Short Summary

Main recommendation: If your high blood pressure does not respond normally to treatment, or it shows signs of an underlying cause, ask your doctor to screen for secondary hypertension, which the speaker says affects up to 20% of people diagnosed with high blood pressure. Secondary hypertension has a identifiable medical cause, such as a hormone, kidney, thyroid, or adrenal problem, and is often fixable once found.

Key Points

• Dr. Berry says most high blood pressure is primary (essential) hypertension, which he believes is almost always linked to high insulin (hyperinsulinemia); he claims a ketogenic or carnivore diet lowers insulin and can reverse it.
• Secondary hypertension is often underdiagnosed because doctors focus on the more common primary type, the "horses, not zebras" principle.
• Red flags include a more than 20-point systolic difference between arms, delayed or absent femoral pulses, abdominal bruit over the kidney arteries, rising creatinine, potassium even slightly low, sleep apnea, and blood pressure that stays high despite several medications.
• Age shapes which causes to check: primary aldosteronism is described as the most often missed cause, with renal parenchymal disease and renovascular hypertension also common.
• Many medications can raise blood pressure, including NSAIDs and COX-2 inhibitors, decongestants, steroids, estrogen-containing pills, stimulants, and certain antidepressants.

Details Worth Noting

• Concrete instructions: Ask your doctor whether a medication you take, such as an NSAID, COX-2 inhibitor, steroid, antihistamine or decongestant, estrogen pill, stimulant, or antidepressant, could be contributing to your blood pressure.
• Concrete instructions: If your blood pressure stays high despite two to four medications, or you have any listed symptoms or signs, ask for a workup for secondary hypertension, and request a referral to a hypertension-focused cardiologist or an endocrinologist if your primary care provider finds nothing.
• Concrete instructions: If you have high blood pressure and have already adopted a low-carb, keto, or carnivore diet without normalizing it, Dr. Berry says that suggests a secondary cause and recommends talking to your doctor about it.
• Concrete instructions:
• The speaker cites estimates that primary aldosteronism affects 10 to 15% of people with hypertension, renal parenchymal disease 2 to 5%, and renovascular hypertension 1 to 2%.
• Symptoms to note include facial flushing, headaches, erratic blood pressure, blood pressure dropping on standing, palpitations, unexplained sweating, fainting, buffalo hump, central obesity with thin limbs, a round face, and unexplained stretch marks.
• The speaker notes that age-based categories are not fixed, so a child or adult outside a typical range can still have a given cause.

Bottom Line

Unexplained, stubborn, or atypical high blood pressure is worth a targeted investigation for a treatable underlying cause, not just routine management. This is Dr. Berry's view and not professional medical advice; he recommends discussing any concerns with your doctor.