| Nonadherence to therapy |
| • Cost of medication and related care |
| • Instructions not clear and/or not given to the patient in writing |
| • Failure of physician to increase or change therapy to achieve blood pressure goals |
| • Inadequate or no patient education |
| • Lack of involvement of the patient in the treatment plan |
| • Side effects of medication |
| • Organic brain syndrome (e.g., memory deficit) |
| • Inconvenient dosing schedule |
| White coat hypertension |
| Pseudohypertension |
| Drug-related causes |
| • Doses too low |
| • Inappropriate combinations (e.g., two centrally acting adrenergic inhibitors) |
| • Rapid inactivation (e.g., hydralazine, oral clonidine [Catapres], captopril [Capoten], short-acting calcium channel blockers) |
| • Drug interactions |
| | Glucocorticoids |
| | Mineralocorticoids |
| | NSAIDs |
| | Tyramine and MAO inhibitors |
| | Appetite suppressants |
| | Phenothiazines |
| | Oral contraceptives |
| | Sympathomimetics |
| | Antidepressants |
| | Adrenal steroids |
| | Nasal decongestants |
| | Cocaine |
| | Cyclosporine (Sandimmune, Neoral) |
| | Erythropoietin |
| Associated conditions |
| • Increasing obesity |
| • Alcohol intake greater than 1 oz of ethanol per day |
| • Sedentary lifestyle |
| • Sleep apnea |
| Volume overload |
| • Inadequate diuretic therapy |
| • Excess sodium intake |
| • Fluid retention from reduction of blood pressure |
| • Progressive renal damage |
| Secondary hypertension |
| • Renal |
| Renal parenchymal disease |
| | Chronic nephritis |
| | Polycystic kidney disease |
| | Collagen vascular disease |
| | Diabetic nephropathy |
| | Hydronephrosis |
| | Acute glomerulonephritis |
| Renal vascular disease |
| Renal transplantation |
| Renin-secreting tumors |
| • Endocrine |
| • Adrenal |
| | Primary aldosteronism |
| | Overproduction of 11-deoxycorticosterone (DOC), 18-OH-DOC, and other mineralocorticoids |
| | Congenital adrenal hyperplasia |
| | Cushing's syndrome |
| | Pheochromocytoma |
| • Extra-adrenal chromaffin tumors |
| • Hyperparathyroidism |
| • Acromegaly |
| Pregnancy-induced hypertension |
| Sleep apnea |
| Coarctation of the aorta |
| Neurologic disorders |
| • Dysautonomia |
| • Increased intracranial pressure |
| • Quadriplegia |
| • Lead poisoning |
| • Guillain-Barré syndrome |
| Postoperative hypertension |
| Isolated systolic hypertension |
| • Aging, with associated aortic rigidity |
| • Increased cardiac output |
| • Thyrotoxicosis |
| • Anemia |
| • Aortic valvular insufficiency |
| Decreased peripheral vascular resistance |
| • Arteriovenous shunts |
| • Paget's disease of bone |
| • Beriberi |