SHOULD ALL SECONDARY CAUSES OF HYPERTENSION BE SCREENED IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION?

Abstract

Objective: Secondary hypertension often presents as treatment-resistant hypertension. Patients with resistant hypertension therefore undergo an extensive workup to identify a potential secondary cause. We aimed to analyze whether it is necessary to screen all patients presenting with resistant arterial hypertension for all secondary causes of hypertension. Design and method: We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation. Results: Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (15.6%), renal parenchymal hypertension (14.8%) and hyperreninism (3.7%). Obstructive sleep apnoea has been found in 14.7% patients. Less common causes were hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). All patients with the last three rare causes presented with specific clinical symptoms (i.e. patient with pheochromocytoma was admitted for paroxysmal hypertension, adrenogenital syndrome was diagnosed in female patient with secondary male sex characteristics, patients with hypercortisolism had typical cushingoid signs). Conclusions: Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). We suggest that first line testing only for primary hyperaldosteronism and renovascular hypertension would be sufficient for patients with resistant hypertension without clinical clues suggestive of another particular secondary cause of hypertension.