Prevalence Of Secondary Hypertension Research Articles

Diagnostic and Therapeutic Approach to the Major Secondary Causes of Arterial Hypertension in Young Adults: A Narrative Review

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.

SECONDARY HYPERTENSION IN THE INTERNAL MEDICINE OUTPATIENT DEPARTMENT OF A PORTUGUESE HOSPITAL

Objective: Secondary hypertension is an uncommon form of hypertension and universal screening is not beneficial or cost-effective. Consequently, investigation is reserved for selected cases, according to clinical suspicion, and is often referred to a specialist. The aim of this study was to characterize the evaluation of secondary hypertension in the Internal Medicine Outpatient Department of a portuguese hospital. Design and method: This longitudinal retrospective study analysed patients referred to our Internal Medicine Outpatient Department for hypertension evaluation in 2021. Patient records and results were analysed, focusing on indication for evaluation, testing performed and identified causes of secondary hypertension. Results: A total of 147 patients were referred for hypertension evaluation, 7 (4,76%) of which were explicitly referred for secondary hypertension screening. Testing was conducted in 105 patients (71,43%), with basic evaluation (CBC, renal function, thyroid function) in 71 patients (48,30%) and additional testing (such as endocrine, renovascular, obstructive sleep apnoea screening) performed in 34 patients (23,13%). Considering age criteria, resistant hypertension, and other clinical clues, 60 patients (40,82%) had a documented indication for additional testing for secondary hypertension. Additional testing was requested in 5 patients (3,40%) not meeting these criteria, most of whom needed testing to follow-up investigations ordered in primary care without clear indication. Conversely, a small proportion (6,12%) met criteria for additional testing that wasn’t requested: 22% already had a previous screening ordered in primary care negative for secondary hypertension; 44% were evaluated for hypertension-mediated organ damage without further screening. Patients in which specific evaluation was complete at the time of this study, a secondary cause was identified in 9 patients (6.12%), all with a previous diagnosis of Obstructive Sleep Apnea. Conclusions: The prevalence of secondary forms identified didn’t significantly differ from the described 5-10% overall prevalence of secondary hypertension and reiterated the identification of OSA as an exceedingly common recognized cause of hypertension. This study emphasised that extensive testing was mostly non-diagnostic and was associated with inconclusive results leading to further investigations, raising costs and risks. This suggests that careful selection of patients and method of screening by a specialist is beneficial.

Evaluation of Patients Performed with Saline Infusion Test with a Pre-Diagnosis of Primary Hyperaldosteronism

Background: Primary hyperaldosteronism (PHA) is a primarily treatable cause of arterial hypertension characterized by low plasma renin and high aldosterone levels. The prevalence of secondary hypertension as a common endocrine cause is 5-13%. The plasma aldosterone/renin ratio (ARR) is the best available method for PHA screening. One or more confirmatory tests may be required to confirm or exclude patients' diagnoses. One frequently used confirmatory test is the saline infusion test (SİT). We aimed to screen the patients who underwent SİT with the preliminary diagnosis of PHA and to compare the results of the patients diagnosed with essential hypertension (EH) and PHA.
 Material and Methods: Seventy-seven patients with a history of drug-resistant hypertension or unexplained spontaneous or diuretic-induced hypokalemia or adrenal incidentaloma, or a family history of early-onset hypertension or cerebrovascular accident at a young age (0.05). Basal plasma aldosterone (p

Secondary hypertension: Clinical presentation, diagnosis, and treatment

Secondary hypertension accounts for about 10% cases of hypertension but it's important to look for it because of its potentially reversible character after treatment of the cause. It can be treated or at least improved by the treatment of the cause. Our study's objective was the etiological profile of secondary hypertension and determine its clinical, therapeutic and evolutive characteristics. It was a retrospective study over a period of 14 years. We recruited 60 hypertensive treated patients from two departments: internal medicine and cardiology. The prevalence of secondary hypertension was 4%. We included 40 men (67%) and 20 women (33%). The average age for hypertension discovery was 42 years. Thirty-eight percent of the patients were less than 40 years old. It was a recent discovery in 35%. The hypertension was stage 3 for 30 patients (50%). The secondary origin of the hypertension was suspected in some cases such us young patients (17%), severe hypertension (30%) and resistant hypertension (12%). Diagnosis signs were found respectively by medical history and physical examination in 45% and 37% of cases. In biology, hypokalemia was noted in 28% of cases. The first etiology of secondary hypertension was renal parenchymal diseases (33%), followed by primary hyperaldosteronism (29%), renal artery stenosis (14%), pheochromocytoma (8%) and hyperthyroidism (8%). An iatrogenic cause was noted in 5% of cases and a Cushing syndrome was found in 3% of cases. The hypertension was monitored by medical and/or surgical treatment in 90% of cases. The most common causes of secondary hypertension are renal parenchymal diseases, primary hyperaldosteronism, and renovascular hypertension. Careful clinical evaluation and a simple exploration algorithm could identify curable causes to avoid long-term medical therapy.

The Impact of Secondary Hypertension in Pregnancy on Maternal and Fetal Outcomes: A 42-Month Observational Study from South India.

To examine the prevalence, etiology, and clinical outcomes of secondary hypertension in pregnancy in a high-risk tertiary care hospital. This retrospective study used data from patient records between January 2015 and July 2018. Of 52,293 pregnant women admitted during this period, those with hypertension were included. Patient demographics, diagnosis of secondary hypertension, investigations, suspected etiologies of secondary hypertension, maternal and neonatal outcomes and discharge conditions were included. The prevalence of secondary hypertension and causes were measured. Univariate followed by multivariate analyses were done to look for associated maternal and neonatal outcomes. Among patients with chronic hypertension in pregnancy, 13.7% had secondary causes, of which renal and cardiac causes were the commonest. The incidence of severe pre-eclampsia (40.5%) among patients with secondary hypertension was higher in patients with systolic blood pressures more than 140mm of Hg than in those with systolic blood pressures lower than 140mm of Hg (odds ratio [OR]: 4.92, confidence interval [CI]: 1.7-14.16, p: 0.002) irrespective of etiology. Pre-eclampsia predisposed to maternal acute kidney injury (OR: 1.23, CI: 1.04-1.45, p: 0.003), low birthweight (OR: 4.69, CI: 1.44-11.9, p: 0.006), preterm delivery (OR: 4.69, CI: 1.78-12.34, p: 0.001), and neonatal death (OR: 5.19, CI: 0.97-27.6, p: 0.04). The prevalence of hypertension in pregnancy was 10.3%; among them, the prevalence of secondary hypertension was 1.46%. Uncontrolled secondary hypertension was associated with poor maternal and neonatal outcomes. Strict control of blood pressure in secondary hypertension in pregnancy ensured better outcomes.

Prevalence of Secondary Hypertension in Children with a New Diagnosis of Hypertension: A Meta-Analysis

Prevalence of Secondary Hypertension in Children with a New Diagnosis of Hypertension: A Meta-Analysis

UNSUSPECTED CAUSES OF HYPERTENSION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pheochromocytomas (PC) are catecholamine-secreting tumors that arise from the chromaffin cells of the adrenal medulla and other extra-adrenal sources. The annual incidence of PC is approximately 0.8 per 100,000 person-years, however this is thought to be an underestimation as a substantial portion of PC's were diagnosed at autopsy (Beard et al). With the relative rarity of this disease coupled with its often-complicated presentation, it is not uncommon to see this disease misdiagnosed. CASE PRESENTATION: We present a 68-year-old Caucasian female with a past medical history significant for chronic tobacco use, hypertension, hypothyroidism secondary to partial thyroidectomy, coronary artery disease, paroxysmal atrial fibrillation, periodic headaches, backpain and dizziness who presented after a fall at home. An elevated troponin with normal EKG led to treatment for NSTEMI. CT head returned within normal limits and a cardiac catheterization revealed LVEF of 35-40% with 60% mid-LAD stenosis and Coreg and Ramipril were started. A few weeks later, she presented to the ED again with chest pain radiating between her shoulder blades. A CTA chest was significant for a 1.7cm soft tissue density in the right lower lung lobe and a 1.6cm right adrenal nodule. A follow-up PET/CT showed a peak SUV (standardized uptake value) of 1.6 in the lung nodule and a peak SUV of 2 in the adrenal gland nodule. Biopsy of the lung nodule via bronchoscopy was unattainable due to its small size and anatomic location. The decision to proceed to a CT-guided needle biopsy of the right adrenal mass was made with pathology returning consistent with a PC. Further evaluation included measurement of urine metanephrines, which returned elevated. Due to continued suspicion of the right lower lobe nodule likely representing an unrelated, early-stage bronchogenic carcinoma, cardiothoracic surgery consultation was obtained. Pathology of the right lower lobectomy with lymph node biopsies returned consistent with adenocarcinoma of likely lung primary origin. DISCUSSION: It is estimated that approximately 0.2-0.6% of patients with hypertension have a concurrent PC (Omura et al). In fact, approximately 15-30% of the population of hypertensive patients have secondary hypertension and resistant hypertension was noted in approximately 34% of hypertensive patients in the ALLHAT trial (Koch et al). This patient's presentation attests to the semi-cryptic nature of PC. CONCLUSIONS: This case also demonstrates that, despite a suspected cardiac etiology and incidental pulmonary malignant process, searching for the overall causation of the patients presenting symptoms may be more difficult than it first appears. After completing a secondary hypertension workup (as well as dietary and lifestyle changes) with unremarkable results it is important to consider endocrinopathies as an underlying cause, despite their rarity. REFERENCE #1: Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. PMID: 6645626. REFERENCE #2: Omura M, Saito J, Yamaguchi K, et al. Prospective Study on the Prevalence of Secondary Hypertension among Hypertensive Patients Visiting a General Outpatient Clinic in Japan. Hypertens Res. 2004;27(3):193–202. REFERENCE #3: Koch C, Papadopoulou-Marketou N, Chrousos GP. Overview of Endocrine Hypertension. 2020 Feb 4. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K, Grossman A, Hershman JM, Hofland J, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Purnell J, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905214. DISCLOSURES: No relevant relationships by David Heintze, source=Web Response no disclosure on file for Billy Rosson

Abstract #1003799: Persistent Hypertension After Adrenalectomy for Pheochromocytoma/Paraganglioma (PPGL) in Young Adult: A Possible Case of Noradrenergic Extra Adrenal PPGL?

The prevalence of secondary hypertension in young adults is approximately 30%, most of which are endocrine disorders such as primary aldosteronism, pheochromocytoma/paraganglioma (PPGL), and Cushing syndrome. Pheochromocytoma and paraganglioma (PPGL) are neuroendocrine tumors that arise from adrenal or extra-adrenal chromaffin cells, and they can occur either sporadically or hereditary. It is a necessity to establish an accurate diagnosis through careful workup to provide optimal treatment.

Urinary sodium/potassium ratio as a screening tool for hyperaldosteronism in men with hypertension

Among individuals with hypertension, the prevalence of secondary hypertension has been reported to be ≈10%. More than half of individuals with secondary hypertension have associated hyperaldosteronism. However, given the current clinical environment, these patients often remain undiagnosed. We hypothesized that the urinary sodium/potassium ratio (Na/K) could be used as a simple, low-cost method of screening for hyperaldosteronism among individuals with hypertension in primary care and health examination settings. We recruited hypertensive individuals aged 30–69 years old who were not taking any antihypertensive medications from among participants in health examinations. Urinary Na and K were measured using second morning urine samples, and the plasma aldosterone concentration (PAC) was also measured. We evaluated the association of the second morning urine Na/K ratio (SMU Na/K) with a high PAC, defined as ≥90th percentile (24.3 ng/dL), using receiver operating characteristic (ROC) curves. Overall, 160 participants (108 men and 52 women) with a mean age of 54.3 years were eligible for this study. The area under the ROC curve for the relationship between SMU Na/K and high PAC was 0.77 (95% confidence interval [CI]: 0.59–0.95) in men and 0.64 (95% CI: 0.36–0.93) in women. In men, SMU Na/K values <1.0 could detect hyperaldosteronism with a sensitivity of 45.5%, a specificity of 97.9%, a positive predictive value of 71.4%, and a negative predictive value of 94.1%. The use of the urinary Na/K ratio may be appropriate as a method of screening for hyperaldosteronism in hypertensive men.

WHAT IS IN THE SHADOW – A CASE OF SECONDARY HYPERTENSION

Objective: To present a case of secondary hypertension, to rule the importance of having evidence based recommendations. Design and method: We describe the case of a diabetic, dyslipidemic 63 years old man, with coronary artery disease-percutaneous coronary intervention (PCI) of right coronary artery (RCA) and of circumflex coronary artery(CCA) in 2016, hypertensive (ambulatory treatment: angiotensin-enzyme inhibitor, a calcium channel blocker, beta blocker and alpha2 central receptors) admitted in internal medicine ward with fronto-occipital headache, dizziness, hypertension (with a blood pressure value of 170/110 mmHg), hypokalemia (K 1.76 mmol/l). Taking into consideration the characteristics of the particularly case presented above, the patient is considered to meet the admission criteria. The abdominal CT scan revealed adrenal gland adenoma (1.8/1.4 cm). The diagnose of primary hiperaldosteronism is confirmed by the value of aldosteron/renine ratio (ARR 17). The patient's blood pressure and hypokalemia was influenced by the dose adjustment to the patient's ambulatory treatment and the administration of antimineralocorticoid and potassium supplement. Results: The new regimen reduced the blood pressure values, normalized the blood pressure and partially increased the potassium level (K 2.82 mmol/l). Conclusions: Although the prevalence of secondary hypertension is approximately 10 % the risks associated with are significantly higher. We reported a case of secondary hypertension with a good outcome despite it's severity.

WHEN WE DON’T HAVE ENOUGH-A CASE OF SECONDARY HYPERTENSION

Objective: Diabetic nephropathy (DN) is a significant cause of chronic kidney disease (CKD) and end-stage renal failure globally. Hypertension is approximately twice as prevalent in patients with diabetes compared to the general population. The major causes of hypertension in DN include activation of local (renal) renine-angiotensin-aldosterone system (RAAS), increased or abnormal sympathetic nervous system (SNS) activity, oxidative stress and abnormal nitric oxide (NO) metabolism. These mechanisms are responsible for the onset and worsening of hypertension in this population. Design and method: We report the case of a type I diabetic 47 years old man, with multiple complications (retinopathy, nephropathy, polineuropathy), stage 5 chronic kidney disease in hemodialysis program, hypertensive (ambulatory treatment: calcium channel blocker, and alpha2 central receptors), presented to the emergency department with tonic-clonic seizure, hypertension (with a blood pressure value of 185/98 mmHg), hyperglycemia (glycemia over 750 mg/dl), metabolic acidosis (ph 7.23), moderate hyponatremia (Na 124 mmol/l). Taking into consideration the characteristics of the particularly case presented above, the patient is considered to meet the admission criteria for intensive care unit (ICU). The evolution was favorable with insulin, acid-base and hydro electrolytic re equilibration, prevention of stress ulcer, venous thromboembolism prophylaxis and anti-hypertensive treatment (nitroglycerine, alpha1-adrenoreceptor blocker- urapidil, angiontensin-converting enzyme inhibitor, calcium channel blocker, loop diuretic) and the patient was transferred to internal medicine ward. Results: Despite the use of the treatment to the maximum tolerated plus the addition of alpha2 central receptors blocker (clonidine), the patient's blood pressure was uncontrolled (maximum 260/130 mm Hg), far from the target. The new regimen reduced the blood pressure values by systolic blood pressure 170 mm Hg. Conclusions: Although the prevalence of secondary hypertension is approximately 10 % the risks associated with are significantly higher. We reported a case of secondary hypertension with uncontrolled values of blood pressure despite maximal treatment.

PREVALENCE OF SECONDARY HYPERTENSION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary hypertension among patients with resistant hypertension is not exactly known. 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, Mann-Whitney U test and Fisher's exact test 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 (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). Less common causes were hyperreninism (3.7%), hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). Obstructive sleep apnoea has been found in 63 (14.7%) patients. Patients with secondary hypertension were more frequently male (70.4% vs. 52.2%, p &lt; 0.001), had a higher left ventricular mass index (LVMI 119 vs. 106 g / m2, P = 0.037) and lower estimated glomerular filtration rate (69 vs. 75 ml/min/1.73m2, P = 0.009). Both groups did not differ in age, office blood pressure or albuminuria. Conclusions: Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Patients with secondary hypertension had more advanced target organ damage. This work was supported by the grant UP - IGA_LF_2019_036 a IGA_LF_2019_035. This work was supported by the grant IGA_LF_2020_039

Screening of Secondary Hypertension in Private Clinic in Karachi, Pakistan: A Randomised Study

Hypertension hasbeen recognized as aglobalhealth concern fordeveloping countries.Secondary hypertension(SH)including endocrine hypertension has been reported to be uncommon and is scarcely described in many of these countries. There is no current nationally representative study. Therefore, we estimated the prevalence of SH among hypertensive patients in private clinic by screening. The goal of the cross-sectional study conducted from May 2017to June2018 was to estimate the prevalence of hypertension inPakistani population based on data collected fromthe screening held at private clinic inKarachi. From the initial screening of 566 patients, we suspected 437 (M:187), (F:250) patients to have secondary hypertension and conducted tests for the cause of hypertension, measured plasma aldosterone concentration, plasma renin activity, serum cortisolconcentrationandplasmacatecholamine concentration.Asasecondary screening,wereferredpatientsforfurosemide plus upright test, captopril renography, dexamethasone suppression test, abdominal ultrasonography (US), abdominal CT. and arteriography investigations. These tests clearly demonstrated that the prevalence of Secondary Hypertension was 8.1% among 437 patients investigated. 42 were found to have Renal parenchymal disease; 25 were having Acute Renal Failure; 15 patients had Calculi; 29 patients had chronic glomerulonephritis leading to CRF and 3 had reno vascular hypertension. Further, 2 cases with aortic coarctation were found on arteriography; 1 patient had primary aldosteronism; 5 had primary hyperparathyroidism; 6 patients had hyperthyroidism and 11 had Hypothyroidism. In seven cases of hydronephrosis (two known and five newly detected) we could not determine whether the hypertension was caused by the hydronephrosis. The prevalence of curable SH among hypertensive subjects was higher in this screening study, conducted in majority of cases with simple tests. The rates of blood pressure screening in Pakistan are worryingly low; the underlying disease in hypertensive patientsshould be treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complication. This calls for the establishment of a nationwide program on screening to improve detection, awareness and treatment of hypertension.

Screening for endocrine hypertension. An Endocrine Society scientific statement

Hypertension may be the initial clinical presentation for at least 15 endocrine disorders. An accurate diagnosis of endocrine hypertension provides clinicians with the opportunity to render a surgical cure or to achieve an optimal clinical response with specific pharmacologic therapy. It is challenging for the clinician to know when and how to perform case-detection testing for all the endocrine disorders in which hypertension may be the presenting symptom. Herein, we review the different forms of endocrine hypertension, with a focus on prevalence, clinical presentation, guidance on when to perform case detection testing, and currently available case-detection tests.Hypertension affects 28.6% of adults in United States. In most, hypertension is primary (essential or idiopathic), but a subgroup of approximately 15% has secondary hypertension. More than 50% of children who present with hypertension have a secondary cause. In young adults (< 40 years old), the prevalence of secondary hypertension is approximately 30%. The secondary causes of hypertension include renal causes (e.g., renal parenchymal disease) and endocrine causes. Hypertension may be the initial clinical presentation many endocrine disorders: pheochromocytoma and sympathetic paraganglioma, primary aldosteronism, hyperdeoxycorticosteronism (congenital adrenal hyperplasia – 11b-hydroxylase deficiency, 17a-hydroxylase deficiency, deoxycorticosterone-producing tumor, primary cortisol resistance), cushing syndrome, apparent mineralocorticoid excess / 11b-hydroxysteroid dehydrogenase deficiency, hyperparathyroidism, secondary hyperaldosteronism, renovascular hypertension, hypothyroidism, hyperthyroidism, obstructive sleep apnea and others.Clinical context is important. For example, case detection for endocrine hypertension may not be clinically important in an older patient with multiple life-limiting comorbidities. However, screening for endocrine hypertension may be key to enhancing and prolonging life in most patients with hypertension, especially younger patients.

Abstract 094: Predicting the Risk of Apparent Treatment Resistant Hypertension: A Retrospective, Longitudinal, Cohort Study in an Urban Hypertension Referral Clinic Setting

Background: Apparent treatment resistant hypertension (aTRH) is associated with increased prevalence of secondary hypertension and adverse pressure-related clinical outcomes. We previously showed that cross-sectional prevalence estimates of aTRH are lower than its true prevalence as patients with uncontrolled hypertension undergoing intensification/optimization of therapy will, over time, increasingly satisfy diagnostic criteria for aTRH. Methods: aTRH (SBP and/or DBP at or above a clinically defined goal BP [140/90, 130/85, 130/80, or 125/75 mmHg] over two consecutive office visits when on ≥ 3 antihypertensive drug classes, including a diuretic; or SBP and DBP below goal when on ≥ 4 drug classes, including a diuretic) was assessed in an urban referral hypertension clinic in 924 patients ≥ 30 years old (57.7 ± 12.6) with at least two follow-up visits over 240 days. Patients were mostly African-American (86%; 795/924) and female (65%; 601/924). A minority (28.7%; 265/924) were taking diuretics at their index visit, and analyses were stratified according to this use. Risk for aTRH was estimated using logistic regression with patient characteristics at index visit as predictors. Performance of this risk score at discriminating aTRH status over follow-up was assessed using AUC and was internally validated using bootstrapping. Results: Amongst those on diuretics, 80/265 (30.2%) developed aTRH; the risk score discriminated well (AUC = 0.79, bootstrapped 95% CI [0.73, 0.84]). In patients not on a diuretic, 151/659 (22.9%) developed aTRH, and the risk score showed moderate, but significantly lower, discriminative ability (AUC = 0.71 [0.66, 0.74]; p &lt; 0.001). In the diuretic and non-diuretic cohorts, 43/265 (16.2%) and 101/265 (38.1%) of patients, respectively, had estimated risks for development of aTRH &lt; 10%. Of these low-risk patients, 42/43 (97.7%) and 97/101 (96.0%) did not develop aTRH (negative predictive value, diuretics – 0.95 [0.93, 1.00], no diuretics – 0.96 [0.91, 1.00]). Conclusions: We created a novel clinical score that discriminates well between those who will and will not develop aTRH, especially amongst those taking diuretics initially. Irrespective of diuretic treatment status, a low risk score had very high negative predictive value.

Causes of secondary hypertension in the young population: A monocentric study

ObjectiveTo study the prevalence of different causes of hypertension in young adults referred to a hypertension center in the south west of France. MethodsWe conducted a retrospective overview of patients younger than 40years old hospitalized consecutively in the Hypertension department of Toulouse University Hospital between 2012 and 2014. Clinical data about gender, age, anthropomorphic parameters and blood pressure measurement by 24h Ambulatory Blood Pressure Monitoring (ABPM) were recorded. Biological data concerned dosages of kalemia, renin and aldosterone in the supine or after 15min of seating. Recorded radiological examinations were renal artery ultrasound and abdominal CT scan. ResultsOne hundred and forty-eight detailed medical records were analyzed, 69 women and 79 men. Among the 69 women, the causes of secondary hypertension were primary aldosteronism (n=7), fibromuscular dysplasia (n=5) and renal disease (n=4). Oral contraceptives were involved in 13 women. In addition, essential hypertension concerned 40 women (58%). Among the 79 men, the causes of secondary hypertension were primary aldosteronism (n=10), fibromuscular dysplasia (n=3), left main renal artery entrapment by a diaphragmatic crura (n=2), renal disease (n=1), pheochromocytoma (n=3) and coarctation of the aorta (n=2). In addition, essential hypertension concerned 58 men (73%). ConclusionsIn our population, the prevalence of secondary hypertension is close to 33% (42% of females and 27% of males), with the following main causes: primary aldosteronism for 11.5%; fibromuscular dysplasia for 5.4%. Oral contraceptives were involved in the hypertension of 19% of the females.

P3-24: Secondary hypertension in a tunisian internal medicine department

Secondary hypertension (SH) refers to arterial hypertension due to an identifiable and often curable cause. It affects approximately 5-10% of the general hypertensive population. SH can be caused by conditions that affect kidneys, arteries, heart or endocrine system. Our aim is to describe the different causes of SH noted in our patients. It is a retrospective study of 240 patients followed for a SH at the Internal Medicine Department of the Tunisian Military Hospital from 2000 to 2015. The diagnosis of SH in these patients was suspected in front of clinical and biological arguments and confirmed by the further explorations guiding a suitable therapeutic attitude. Renal causes were the main etiology of SH (233 patients) with acute glomerular nephritis (AGN) in 4 cases, primary chronic glomerular nephropathy (CGN) in 14 cases, including 8 cases of membranous glomerulonephritis, 2 cases of focal segmental glomerulosclerosis and 4 cases of membrano-proliferative glomerulonephritis. Secondary CGN were dominated by diabetic nephropathy in 174 cases, lupus nephropathy in 10 cases and rheumatoid purpura in one case. Congenital kidney diseases were represented by hereditary polycystic kidney disease in 20 patients and Alport syndrome in 2 patients. The renovascular hypertension was noted in 8 cases. The endocrine causes were present in 6 patients (2 cases of Conn syndrome, 2 cases of hyperthyroidism, 1 case of bilateral adrenal hyperplasia and another case of pheochromocytoma). One patient had SH with a cardiac cause that was aortic coarctation. The prevalence of SH exceeds 30% among patients with resistant hypertension. Common causes include chronic kidney diseases, primary aldosteronism, renovascular hypertension and obstructive sleep apnea. In our study, renal parenchymal disease particularly diabetes is the most common cause of SH. Physicians should be judicious about evaluation of a potentially curable cause of hypertension. Careful clinical evaluation and simple algorithms help avoid unnecessary investigations. In patients with SH, early detection and treatment are important to minimize and prevent irreversible changes in the vasculature and target organs.

High incidence of secondary hypertension in patients referred for renal denervation – the Copenhagen experience

Percutaneous renal denervation is a new treatment option for patients with resistant hypertension and little is known about the eligibility of patients referred. 100 consecutive patients were referred for renal denervation from March 2011 through September 2012. Clinical data were prospectively extracted from letters and documents from referring clinics and from our physical examination. Of the 100 patients included, 68 were men and the mean age was 60 (± 12) years. Office blood pressure was 176 (± 28)/99 (± 19) mmHg and 24-h ambulatory blood pressure 156 (± 20)/88 (± 13) mmHg. The mean number of antihypertensive agents was 4.0 (± 1.6). Nearly four-fifths (82%) of the patients were categorized as having resistant hypertension based on the criteria stated by The American Heart Association's stated criteria. Nine patients declined interest in renal denervation before completing the clinical workup program. Thus, 91 patients were screened, and of those 51 were found to be candidates for renal denervation. Forty patients were not candidates, of which secondary hypertension was the most common cause (n = 10). Only 51% of patients referred for renal denervation were eligible for treatment. The prevalence of secondary hypertension was 10% of the referred population. Secondary hypertension should therefore be considered in the evaluation of candidates for renal denervation.

Coexistence of two causes of secondary hypertension in a single patient

The prevalence of secondary hypertension (SHT) is 4.7--6% in patients with arterial hypertension that are referred to specialist care settings. Diagnosis is desirable, because these types of hypertension are many times resolved. It is uncommon to find two secondary causes simultaneously in the same patient. In a study performed with 1090 patients referred to a clinical unit, Omura et al. found that the prevalence was slightly higher than that previously reported (93 patients with SHT). They found that primary hyperaldosteronism (PHA) was the most frequent etiology, followed by Cushing’s syndrome. Of note, none of those patients had more than one secondary cause. Here, we report a patient who had two secondary etiologies of hypertension diagnosed simultaneously. Both were resolved after they were individually treated, and the patient achieved a normotensive status.

Ruling out secondary causes of hypertension

In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.