Endocrine hypertension: Changing paradigm in the new millennium

Abstract

Hypertension contributes significantly to cardiovascular mortality and morbidity in most parts of the world, and as a contributory modifiable risk factor is found to be second only to smoking.[1] The overall prevalence of hypertension in both developed (e.g. 28.7% in the USA) and developing world (e.g. 20% in India) is alarming.[2,3] The ever increasing prevalence is largely due to the so-called primary or essential hypertension which constitutes more than 90% of hypertensive population. Among those with hypertension, there is a small group described as secondary where a rare identifiable cause can be found and treated in manner that cures the patients. If renovascular and renal parenchymal causes are excluded, the possible cause of secondary hypertension would invariably lie in the endocrine system. In the past, the discussions encompassing the term “endocrine hypertension” would invariably be restricted to the adrenal gland. No doubt, the first or “big three” forms in this category, namely, pheochromocytoma, Cushing's syndrome, and Conn's syndrome, involve the adrenal gland.[4] A PUBMED search for articles using the terms “Endocrinology and Hypertension” strongly supports the observation made above [Figure 1]. Adrenal was the primary topic of discussion in more than one-half of the 100 oldest citations, published during late 1940s and early 1950s.There was not a single article in the category of Diabetes and Metabolic syndrome. Similar analysis of 100 latest citations using the same search term reveals that Diabetes and Metabolic syndrome category, with 40% of articles, has occupied the first place ahead of the adrenal, which is now in second place with 19% articles [Figure 1].