Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Rare Causes of High Blood Pressure


Back in the days when doctors couldn't do much to help hypertension, a great deal of time and effort was expended on looking for the rare types of high blood pressure that maybe we could do something about. One such was a condition known as pheochromocytoma ("Grey-colored tumor" of the adrenal gland.) The chances of finding such a case were remote, so the aphorism grew up that "If you make a diagnosis of pheochromocytoma -- you are probably wrong."

At a recent Grand Rounds session at Jefferson Medical College, the topic was treatment-resistant hypertension. In other words, the situation had now reversed. It was now so routine to be able to control hypertension with drugs, that we have had to invent a new term to describe those remarkably few cases which fail to respond to treatment -- Resistant Hypertension. I could see the young doctors had grown used to this paradox without noticing it was something to comment upon.

It is now my observation we have fallen into the habit of searching for these rare conditions only among cases which first sort themselves out as Resistant Hypertension. From once searching desperately for something to treat, we have grown to assume that something we can treat doesn't need further investigation. Implicit then is the unwarranted assumption that hypertension caused by unusual things like Pheochromocytoma always appears as an instance of Resistant Hypertension. Does anyone know of studies which show this is reliable?

No one answered, so I guess not.

Originally published: Friday, February 25, 2011; most-recently modified: Monday, June 03, 2019