CURRENT INSIGHTS IN THE SCREENING OF SECONDARY HYPERTENSION: A CARDIOLOGIST'S PERSPECTIVE.

Arterial hypertension in young adults, which includes patients between 19 and 40 years of age, has been increasing in recent years and is associated with a significantly higher risk of target organ damage and short-term mortality. It has been reported that up to 10% of these cases are due to a potentially reversible secondary cause, mainly of endocrine (primary aldosteronism, Cushing's syndrome, and pheochromocytoma/paraganglioma), renal (renovascular hypertension due to fibromuscular dysplasia and renal parenchymal disease), or cardiac (coarctation of the aorta) origin. It is recommended to rule out a secondary cause of high blood pressure (BP) in those patients with early onset of grade 2 or 3 hypertension, acute worsening of previously controlled hypertension, resistant hypertension, hypertensive emergency, severe target organ damage disproportionate to the grade of hypertension, or in the face of clinical or biochemical characteristics suggestive of a secondary cause of hypertension. The 2023 Guideline of the European Society of Hypertension recommends starting pharmacological therapy from grade 1 hypertension (BP ≥140/90 mm Hg), with the aim of achieving BP control of less than 130/80 mm Hg. It is important to highlight that the prevalence of secondary hypertension in these patients could be underestimated, given that there is little evidence available on the management of high BP in young adults, which is why we developed this narrative review on the diagnostic and therapeutic approach to the major secondary causes of arterial hypertension in young adults.

Resistant Hypertension: Diagnosis and Management.

Objective: We aimed to identify childhood risk factors for high blood pressure (BP) in young adults. Design and method: Childhood data were obtained from medical checkups of Japanese male and female junior high school students aged 12-13 years during the period from 2008 to 2009. Childhood variables were sex, body weight, body mass index (BMI), systolic BP, complete blood count, uric acid, total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. The 1129 participants were followed up for average 8.6 years with a range of 6.0 to 9.0 years. High BP was defined as elevated BP and hypertension of ACC/AHA BP category (systolic BP 120 mmHg or more and/or diastolic BP 80 mmHg or more). Results: At the follow-up, the prevalence of high BP was 42.2% in male young adults and 7.7% in female young adults. The mean systolic/diastolic BP was 117.8 [SD, 10.1] / 63.6 [SD, 6.1] mmHg in men and 105.2 [SD, 9.6] / 59.6 [SD, 5.5] mmHg in women. Univariable logistic regression analysis showed that systolic BP (odds ratio 1.56), body weight (1.50), uric acid (1.38), and red blood cell (1.31) at childhood baseline were significantly associated with high BP in male young adult, whereas variables associated with high BP were not found in female young adults because few women developed high BP. A logistic regression analysis with the stepwise method indicated that the regression model including systolic BP, body weight, WBC, platelet count, and uric acid had a high prediction power for high BP in male young adults (Area under curve 0.660, p < 0.001). Conclusions: These results suggest that childhood medical checkup information including BP, anthropometric data, and laboratory parameter can contribute to the prediction of future high BP in young adults.

Objectives: Hypertension has emerged as a significant public health issue in India. While traditional anthropometric measures have limitations in accurately evaluating body fat distribution, the neck-to-height ratio (NtHR) has emerged as a promising anthropometric indicator for cardiovascular risk assessment. This study aimed to assess the relationships between NtHR, physical activity levels, and relative handgrip strength with blood pressure (BP) in young Indian adults. Materials and Methods: This cross-sectional study recruited 415 healthy young adults (200 males and 215 females) aged 18–30 years. BP was measured using a validated Omron HBP 1300 monitor. Anthropometric measurements included neck circumference, height, weight, and waist circumference. Physical activity was assessed using the International Physical Activity Questionnaire. Relative handgrip strength was calculated by dividing maximum grip strength by body mass index (BMI). Results: NtHR demonstrated a strong positive association with both systolic and diastolic BP in both genders, with stronger associations in females. Multiple regression analysis revealed that NtHR was the strongest predictor of systolic BP in both genders (males: β = 0.731 and females: β = 0.763). Relative handgrip strength and physical activity showed significant negative associations with BP, with stronger protective effects in females. Receiver operating characteristic analysis established optimal NtHR cut-off values for detecting hypertension (males: 20.77 and females: 19.87) and prehypertension (males: 19.20 and females: 18.54). Conclusion: NtHR is a strong predictor of BP in young adults, with gender-specific patterns observed. The findings emphasize the potential of simple anthropometric measurements as effective screening tools for cardiovascular risk, particularly in resource-limited settings.

To determine whether serum urate reduction with allopurinol lowers blood pressure (BP) in young adults and the mechanisms mediating this hypothesized effect. We conducted a single-center, randomized, double-blind, crossover clinical trial. Adults ages 18-40 years with baseline systolic BP ≥120 and <160 mm Hg or diastolic BP ≥80 and <100 mm Hg, and serum urate ≥5.0 mg/dl for men or ≥4.0 mg/dl for women were enrolled. Main exclusion criteria included chronic kidney disease, gout, or past use of urate-lowering therapies. Participants received oral allopurinol (300 mg daily) or placebo for 1 month followed by a 2-4 week washout and then were crossed over. Study outcome measures were change in systolic BP from baseline, endothelial function estimated as flow-mediated dilation (FMD), and high-sensitivity C-reactive protein (hsCRP) levels. Adverse events were assessed. Ninety-nine participants were randomized, and 82 completed all visits. The mean ± SD age was 28.0 ± 7.0 years, 62.6% were men, and 40.4% were African American. In the primary intent-to-treat analysis, systolic BP did not change during the allopurinol treatment phase (mean ± SEM -1.39 ± 1.16 mm Hg) or placebo treatment phase (-1.06 ± 1.08 mm Hg). FMD increased during allopurinol treatment periods compared to placebo treatment periods (mean ± SEM 2.5 ± 0.55% versus -0.1 ± 0.42%; P < 0.001). There were no changes in hsCRP level and no serious adverse events. Our findings indicate that urate-lowering therapy with allopurinol does not lower systolic BP or hsCRP level in young adults when compared with placebo, despite improvements in FMD. These findings do not support urate lowering as a treatment for hypertension in young adults.

The purpose of this study was to examine the relationships between physical activity, a family history (FH) of coronary heart disease (CHD), and blood pressure (BP) in young adults. We were specifically interested in determining whether the relationship between moderate-to-vigorous physical activity and BP was modified by a FH of CHD. Subjects were 230 (103 males, 127 females) university students. Family history was self-reported and habitual physical activity was assessed with a 3-day activity diary. Indicators of habitual physical activity included estimated daily energy expenditure (EE) and EE in moderate-to-vigorous physical activity (MVPA) [median metabolic equivalent (MET) > or =4.8] and inactivity (IA) (MET<2.8). Blood pressure was measured by an automated device according to standard procedures. A large proportion of the sample (63% of males and 68% of females) reported a FH of CHD. In general, correlations between physical activity and BP were low (r<0.30), but in the expected direction (i.e., positive for IA and negative for MVPA and EE). In males IA was significantly related to BP (r =0.25-0.29), but MVPA was not significantly related to BP (r= -0.01 to -0.16). In females diastolic BP was significantly related to IA (r= -0.21) and total EE (r= -0.18). Total EE was significantly correlated to DBP (r= -0.22) in males and to mean arterial pressure (r= -0.18) in females. No significant differences in BP were found between subjects with or without a FH of CHD. Slightly stronger correlations emerged between MVPA and BP for subjects with a negative FH of CHD compared to those with a positive FH of CHD. These data show a significant association between sedentary behavior and blood pressure in young adults. It is suggestive that the magnitude of the relationship between MVPA and BP may be modified by a FH of CHD. Thus, individuals with a FH of CHD may not be as responsive to increased levels of MVPA compared to those without a FH of CHD.

ABSTRACTThis study aims to fill this gap by leveraging Global Burden of Disease 2021 (GBD 2021) data to conduct a comprehensive assessment of the disease burden attributable to high systolic blood pressure (SBP) in young adults. Data from the Global Health Data Exchange were utilized to estimate the disease burden attributable to high SBP in young adults, stratified by overall disease, sex, socio‐demographic index (SDI) level, GBD region, nation, and specific disease. In 2021, the overall disease attributable to high SBP in young adults was substantial, with approximately 24,626,362 disability‐adjusted life years (DALYs) and 477,992 deaths, and the DALYs and mortality rates were 623.68 and 12.11 per 100,000 populations, respectively. The DALYs and mortality rates of specific disease were highest for ischemic heart disease (IHD), followed by intracerebral hemorrhage (ICH), and hypertensive heart disease (HHD). From 1990 to 2021, the DALYs and mortality rates for overall disease attributable to high SBP in young adults showed no significant change.However, there were greater declines in HHD and ICH, while the majority of diseases exhibited an upward trend. The DALYs and mortality rates for overall disease attributable to high SBP in young adults showed no significant change in females but increased in males. The SDI regions like middle and low‐middle SDI regions, GBD regions like Oceania and Caribbean, and countries like Lesotho and Zimbabwe presented the largest increases in the DALYs and mortality rates for overall disease attributable to high SBP in young adults. The trends for certain diseases attributable to high SBP in young adults, when analyzed by sex, SDI level, and region, diverge from the overall disease trends. This study highlights the significant overall disease burden attributable to high SBP in young adults. Despite an overall steady trend in the DALYs and mortality rates since 1990, significant disparities persist across overall diseases, sexes, SDI levels, regions, countries, and specific diseases. These disparities highlight the need for strategic interventions to reduce the health impact of high SBP in young adults.

Introduction: At-risk drinking is associated with an increased risk of cardiovascular diseases (CVD) even in young adults. However, this association is mainly based on offce blood pressure (BP) measurement. Ambulatory BP monitoring captures diurnal variation in BP and is a more sensitive CVD predictor than offce BP. Therefore, the purpose of this study is to investigate the effects of at-risk drinking on ambulatory BP in young healthy adults with normal offce BP. Method: A total of 20 healthy men and women (21-35 years), non-smokers, were included in this cross-sectional study. All participants had an offce BP lower than 130/80 mmHg. Using the US Alcohol Use Disorders Identification Test (USAUDIT), at-risk drinkers were defined as those having a total USAUDIT score higher than 7 for men (6 for women). All participants underwent 24-hour ambulatory BP monitoring (Oscar 2™, SunTech Medical®). To investigate the vascular mechanisms underlying the effects of at-risk drinking on ambulatory blood pressure, aortic arterial stiffness and wave reflection were measured as pulse wave velocity (PWV) and augmentation index (AIx) by using SphygmoCor XCEL system (AtCor Medical). Results: No differences were found in age and BMI between at-risk drinkers (n=10) vs. low-risk drinkers (n=10; mean ± SD for age: 26.7 ± 3.7 vs. 26.6 ± 4.3 years, P&gt;0.99 and BMI: 24.5 ± 2.4 vs. 23.8 ± 2.9 kg/m2, P=0.6). At-risk drinkers had a higher total USAUDIT score (10.6 ± 2.7 vs. 1.4 ± 1.2, p&lt;0.001). While there was no difference between at-risk drinkers and low-risk drinkers in 24-hour, daytime, and nighttime systolic and diastolic BP (P≥0.5), at-risk drinkers had a higher blood pressure morning surge compared to low-risk drinkers (systolic: 34 ± 10 vs. 22 ± 6 mmHg, P=0.014 and diastolic: 29 ± 9 vs. 15 ± 4 mmHg, P=0.002). No significant difference was found in PWV (5.7 ± 0.6 Vs. 5.5 ± 0.7 m/sec, P=0.4) and AIx (8 ± 8 Vs. 15 ± 11, P=0.1). Conclusion: Our results indicate that despite similar offce BP, young adult at-risk drinkers had higher BP morning surge, an independent risk factor for cardiovascular events, than low-risk drinkers. These findings provide implications in using USAUDIT and out-of-offce BP measurements for cardiovascular disease risk assessment. This work was supported by NIAAA AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Background: The youth of this era are the sufferings of overweight and obesity because of sedentary lifestyle, eating habits, altered pattern of behaviour and mental stress. Abdominal obesity is a predominant risk factor of cardiovascular disease. With this background, this study was proposed to correlate abdominal obesity with blood pressure (BP) in young adults. Materials and Methods: A total of 205 young male adults of 20–25 years were selected from various local educational institutions. Estimation for waist circumference (WC), hip circumference (HC) and BP recording was done. Waist–hip ratio (WHR) was calculated from WC and HC. Recording of BP was performed between 8 and 9 am after 5–10 min rest. On the basis of WC, participants were classified into two groups, i.e., WC ≤90 cm and WC >90 cm. On the basis of WHR, participants were classified into two groups, i.e., WHR <0.90 and WHR ≥0.90. Results: In the present study, we found that the participants those WC and WHR above the cut-off value shown significantly more BP (both systolic and diastolic) than normal. Likely, the pulse pressure was higher in participants WC and WHR above cut-off value but not significant. We found a positive correlation between WC and WHR with BP. Conclusion: This study suggested that WC and WHR have a positive correlation with BP and hence concluded that adults with abdominal obesity are at higher risk to develop CVD in their future life.

High blood pressure (BP) in middle-aged and older adults is associated with a brain white matter (WM) microstructural abnormality. However, little evidence is available in healthy young adults. We investigated the associations between high BP and WM microstructural integrity in young adults. This study included 1015 healthy young adults (542 women, 22-37 years) from the Human Connectome Project. Brachial systolic and diastolic BP were measured using a semiautomatic or manual sphygmomanometer. Diffusion-weighted magnetic resonance imaging was acquired to obtain diffusion tensor imaging metrics of free water (FW) content, FW-corrected WM fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity. Using whole-brain voxel-wise linear regression models and ANCOVA, we examined associations of BP and hypertension stage with diffusion tensor imaging metrics after adjusting for age, sex, education, body mass index, smoking status, alcohol consumption history, and differences in the b value used for diffusion magnetic resonance imaging. Systolic and diastolic BP of the sample (mean±SD) were 122.8±13.0 and 76.0±9.9 mm Hg, respectively. Associations of BP with diffusion tensor imaging metrics revealed regional heterogeneity for FW-corrected fractional anisotropy. High BP and high hypertension stage were associated with higher FW and lower FW-corrected axial diffusivity, FW-corrected radial diffusivity, and FW-corrected mean diffusivity. Moreover, associations of high diastolic BP and hypertension stage with high FW were found only in men not in women. High BP in young adults is associated with altered brain WM microstructural integrity, suggesting that high BP may have damaging effects on brain WM microstructural integrity in early adulthood, particularly in men.

The incidence of cardiovascular diseases (CVDs) is beginning to appear in children. Identifying CV risk factors at an early stage of life can provide direction for managing CVDs. This study tested the hypothesis that an association exists between CV risk factors and blood pressure (BP) in young adults. 91 young (18 – 36 years) adults (36 males, 55 females) from ethnically diverse backgrounds at Texas Southern University were evaluated for CV risk factors: race, gender, family history, residence (urban/rural), BMI, waist circumference (WC) and correlated with BP (sitting and standing) and pulse rate (PR). Results indicate that BMI correlated positively with WC and BP across all ethnic groups. The correlation was greater in males (p&lt;0.05) and in Asians compared with other races (p&lt;0.05). BP was higher (p&lt;0.05) in Blacks than Asians and Whites but not different between Blacks and Hispanics. Urban dwellers have higher (p&lt;0.05) BP compared with suburban and/or rural settlers. Family history of hypertension revealed no significant effect on BP and PR across all the races, gender, and age groups. Similarly, there was no significant difference in CV parameters across the different age groups in this study. We conclude from these data that BMI and WC are the most predictive CV parameters for BP in young adults and this is gender‐dependent. Contrary to popular belief, these CV risk factors are most predictive in Asians not Blacks.

The case favoring renal artery stenting for individuals with renal artery hypertension is largely circumstantial. At best, the clinical evidence presented in this discussion is derived primarily from nonrandomized cohort studies. It would certainly be easier to argue that medical therapy is preferred for such individuals because there are 3 published randomized clinical trials that concluded just that and none that support renal artery intervention. Nonetheless, there is considerable evidence to support the role for revascularization in general, and stenting specifically, as an important adjunctive therapy to medical therapy in the care of patients with renal artery stenosis (RAS). The argument has 3 principal components: observations about the impact on cardiovascular physiology, end-organ effects, and natural history. Response by Dworkin and Jamerson p 270 RAS is associated with and is an important cause of secondary hypertension. RAS causes endocrine activation with release of renin from renal juxtaglomerular cells. Renin catalyzes the breakdown of angiotensinogen to angiotensin I. Angiotensin I is transformed by angiotensin-converting enzyme into angiotensin II, and angiotensin II promotes the release of aldosterone from the adrenal cortex.1 Angiotensin II is a potent vasoconstrictor,2 substantially more potent than epinephrine, and is implicated in end-organ damage in the heart3 and kidney.4 RAS is suggested to cause 2 types of hypertension. With unilateral RAS and a normally perfused and normally functioning contralateral kidney, blood pressure elevation is referred to as “renin dependent” and is characterized by increased peripheral resistance.5,6 In this circumstance, renin and angiotensin levels remain elevated, but volume expansion is limited by natriuresis of the contralateral normally functioning kidney.6 Importantly, although renin levels are elevated, the value of peripheral or even renal vein renin values is limited by substantial overlap with patients having essential hypertension.7,8 When stenoses are bilateral or when the …

To explore the clinical features of coexisting primary aldosteronism (PA) and renal artery stenosis (RAS), we retrospectively analyzed records from 71 patients with PA with RAS and a control group of 121 patients with PA without RAS. Aldosterone-to-renin concentration ratio tests and computerized tomography (CT) scanning of the adrenal and renal arteries were routinely conducted to screen for PA and RAS. Color Doppler flow and/or magnetic resonance imaging were used as substitute testing of patients for whom CT was contraindicated. Standard percutaneous renal arteriography (PTRA) was considered for patients with RAS exceeding 70% based on non-invasive tests and for those without PTRA contraindications. The patients with PA with RAS were further divided into severe (RAS>70%) and moderate (50% < RAS <70%) RAS groups. The prevalence of RAS among PA patients was 6.9% (71/1,033), including 3.2% (33/1,033) with severe RAS. Compared with the PA without RAS group, the severe RAS group showed higher levels of systolic blood pressure (SBP) (171.82 ± 18.24 vs. 154.11 ± 18.96 mmHg; P < 0.001) and diastolic BP(DBP) (110.76 ± 15.90 vs. 91.73 ± 12.85 mmHg; P < 0.001) and prevalence of resistant hypertension (RH) (90.9 vs. 66.9%; P = 0.008), whereas the moderate RAS group merely showed higher DBP (98.63 ± 14.90 vs. 91.73 ± 12.85 mmHg; P = 0.006). The direct renin concentrations (DRCs) (5.37 ± 3.94 vs. 3.71 ± 2.10 μU/mL; P < 0.001) and false-negative rate (33.8 vs. 3.3%; P < 0.01) of PA screening tests were significantly higher in the PA with RAS group than in the control group, but only in severe RAS group, in subgroup analysis. Among patients who underwent successful treatment for severe RAS, mean DRC decreased from 11.22 ± 9.10 to 3.24 ± 2.69 μIU/mL (P < 0.001). Overall, the prevalence of RH decreased from 81.7 to 2.8% (P < 0.001) when both PA and RAS were treated with standard methods. PA with concurrent severe RAS is a condition that induces RH. PA can be easily missed in patients with coexisting RAS. RAS patients with RH after successful revascularization for RAS should be evaluated for coexisting PA.

Serum nitric oxide levels are associated with blood pressure in young adults with central obesityBackground: Central obesity is a risk factor for hypertension, which is closely related to the presence of endothelial dysfunction and associated with levels of nitric oxide (NO). Objective: This research was conducted to determine the relationship between NO and blood pressure (BP) in young adults with and without central obesity and also to compare the NO levels and BP between the two groups. Methods: This cross-sectional study was conducted in Pekanbaru, Riau, Indonesia, with 80 young adult subjects aged 18-25 years by consecutive sampling, consisting of 40 subjects with central obesity (waist circumference (WC) ≥90 cm and ≥80 cm for men and women, respectively) and 40 subjects without central obesity (WC &lt;90 cm and &lt; 80 cm for men and women, respectively). Blood pressure was measured using a digital sphygmomanometer, and NO levels were measured using Griess methods. The statistical analysis begins with the normality test of the data, normal data was analyzed with the Pearson correlation test, and abnormal data was analyzed with the Spearman test. Differences in the levels of NO, systolic blood pressure (TDS), and diastolic blood pressure (TDD) between groups was analyzed with the Mann-Whitney-U test.Results: Most of the subjects had high NO levels (66.3%). NO levels had a positively significant relationship with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in total subjects (r = 0.503, p &lt;0.05; r= 0.289, p&lt;0.05, respectively) and with SBP in subjects with central obesity (r = 0.324, p &lt;0.05) but there was no significant relationship in normal subjects. There is a significant difference between serum NO levels, SBP, and DBP between subjects with central obesity and normal subjects (p &lt;0.05).Conclusion: NO levels have a positive significant relationship with SBP and DBP in total subjects and with SBP in young adults with central obesity.

Analysis of the Third National Health and Nutrition Examination Survey (1988 to 1994) suggests that chronic kidney disease (CKD) is a major public health problem (1). Approximately 11% of the US population has CKD. Roughly half have a GFR <60 ml/min per 1.73 m2 with or without kidney damage (stages 3 to 4), and half have exclusively kidney damage as manifested by microalbuminuria (stages 1 to 2) (2). It is widely recognized that the prevalence of stage 5 CKD is also increasing at a rapid rate, and it is estimated that the number of patients who have ESRD may reach 2.24 million by 2030 (3). Evidence to establish reduced GFR as an independent risk factor for cardiovascular disease (CVD) mortality has emerged. Analysis of data from several population-based epidemiologic studies (4,5) demonstrates poorer outcomes regarding stroke, myocardial infarction, and congestive heart failure (CHF) in patients with even mild compromise of kidney function. The morbidity of this group of patients constitutes an economic burden both directly in terms of resource utilization and indirectly through loss of productivity and impaired quality of life (2). Atherosclerotic renovascular disease (ARVD) can result in renovascular hypertension. However, ARVD is an increasingly recognized cause of CKD (6,7). In this article, we focus mainly on ARVD or renal artery stenosis (RAS) secondary to atherosclerosis as a cause of ischemic nephropathy. ARVD is a disease of aging, and several studies have shown its strong association with extrarenal atherosclerotic disease (8–10). Patients with ARVD seem to be at a much greater risk for cardiovascular death than for progressing to renal replacement therapy (11). Whether renal revascularization can benefit renal and cardiovascular outcomes has not been established. Atherosclerosis is the cause of approximately 90% of RAS in adults who are older …