Prevalence Of Secondary Hypertension Research Articles

Management of Resistant Hypertension

“Resistant” hypertension has been variously defined, but most authors accept a definition that includes a blood pressure ≥140/90 mm Hg after prescription of a diuretic and typically two other appropriately chosen antihypertensive drugs at near-maximal doses. Patients with resistant hypertension are of great public health importance because they have a high absolute cardiovascular and renal risk, greater health care expenditures, a higher prevalence of secondary hypertension and target-organ damage, and are, by definition, more “difficult to control” than hypertensive patients who are controlled with only one or two medications. Centers that specialize in these patients report that more than 90% can be diagnosed with a specific cause of their treatment resistance, and more than 50% can be controlled in a relatively short time after an appropriate intervention. This article reviews the differential diagnosis, evaluation, and outcomes of treatment paradigms for such patients, and emphasizes the role of hypertension specialists in their management.

Secondary Hypertension: The Ways of Management

The prevalence of secondary hypertension is lower than that of primary (essential) hypertension, but it is likely that it has been underestimated because appropriate tests were not generally performed. Hence, before embarking on a search for secondary hypertension physicians are generally advised to select populations of patients with a high pre-test probability of secondary forms of hypertension in order to maximize the positive predictive value and the gain in "ruling in" of the diagnostic tests. Based on updated information on prevalence and pathophysiology we herein critically review the general diagnostic strategy and the management of the main forms of secondary hypertension. In particular, strategies for identifying primary aldosteronism, the most frequent form of endocrine secondary hypertension, and for determining its unilateral or bilateral causes are discussed in details, because of the differences of treatment that requires adrenalectomy in the unilateral forms and mineralocorticoid receptor blockade in the bilateral forms. The tests available for the diagnosing pheochromocytoma (pheo), which is much rarer but extremely important to identify, as it can be fatal if unrecognized are also discussed, with emphasis on the recent developments in genetic testing. Renovascular hypertension is also a common curable form of hypertension, which should be identified as early as possible to avoid the onset of cardiovascular target organ damage and events, is also discussed.

Maladie hypertensive des personnes nées en Afrique subsaharienne adressées à un service spécialisé: étude transversale comparative

Hypertensive disease is reported to be more severe in black patients than in white patients, but most available data concern African-Americans. We studied blood pressure history and levels, the prevalence of associated risk factors, renal and cardiovascular complications, and secondary forms of hypertension in patients born in sub-Saharan Africa and managed in France, by comparison with up to five control patients born in Europe and matched for age and sex. Compared to European hypertensive women, African hypertensive women had a higher body-mass index (28.8 vs 26.3 kg/m2, p<0.001) and were more often diabetic (12 vs 5%, p<0.001). Hypertensive men and women born in sub-Saharan Africa had higher systolic blood pressure (152 vs 148 mmHg, p<0.001), were more likely to have a history of stroke (11.7 vs 6.7%, p<0.001) and were less likely to have a history of smoking or hyperlipidemia than European controls. Sub-Saharan Africans were more frequently given antihypertensive medication than their paired controls (84 vs 74%, p<0.001), and their antihypertensive regimens were more likely to include a diuretic (54 vs 46%, p=0.001) or a calcium channel antagonist (58 vs 49%, p=0.001). Compared to European controls, patients born in sub-Saharan Africa had more frequent proteinuria (test strip positivity : 32 vs 18%, p<0.001), irrespective of blood pressure and diabetes. The overall prevalence of secondary hypertension was similar in the two populations. However, patients born in sub-Saharan Africa were more likely than their European controls to have primary hyperaldosteronism (12 vs 7%, p=0.001) and less likely to have renovascular disease (1 vs 5%, p=0.001). Thus, the higher prevalence of cardiovascular and renal complications at referral among patients born in sub-Saharan Africa relative to age- and sex-matched European patients does not seem to be explained solely by observed differences in blood pressure or associated risk factors. The difference in the distribution of secondary hypertension warrants further study.

Clinical Use of Laboratory Tests for the Identification of Secondary Forms of Arterial Hypertension

The prevalence of secondary hypertension can be underestimated if appropriate tests are not performed. The importance of selecting patients with a high pre-test probability of secondary forms of hypertension is first discussed. The laboratory tests currently used for seeking a cause of hypertension are critically reviewed, with emphasis on their operative features and limitations. Strategies to identify primary aldosteronism, the most frequent form of secondary hypertension, and to determine its unilateral or bilateral causes are described. Treatment entails adrenalectomy in unilateral forms, and mineralocorticoid receptor blockade in bilateral forms. Renovascular hypertension is also a common, curable form of hypertension, that should be identified as early as possible to avoid the onset of cardiovascular target organ damage. The tests for its confirmation or exclusion are discussed. The various tests available for the diagnosis of pheochromocytoma, which is much rarer than the above but extremely important to identify, are also described, with emphasis on recent developments in genetic testing. Finally, the tests for diagnosing some rarer monogenic forms and other renal and endocrine causes of arterial hypertension are explored.

Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan.

Secondary hypertension (SH) including endocrine hypertension has been reported to be uncommon. We estimated the prevalence of SH among hypertensive patients. We prospectively studied 1,020 hypertensive patients. As an initial screening, we measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration and plasma catecholamine concentration and conducted abdominal ultrasonography (US). As a secondary screening, we performed furosemide plus upright test, captopril renography, dexamethasone suppression test, 24-h urine catecholamine measurement and abdominal CT. Finally, primary aldosteronism with the exception of idiopathic hyperaldosteronism, pheochromocytoma, and Cushing's syndrome were diagnosed by histopathological examination of surgical specimens. Idiopathic hyperaldosteronism was clinically diagnosed by adrenocorticotrophic hormone (ACTH)-stimulated adrenal venous sampling and renovascular hypertension by renal arteriography. There were 61 patients with primary aldosteronism, 5 with renovascular hypertension, 11 with Cushing's syndrome, 10 with preclinical Cushing's syndrome and 6 with pheochromocytoma, and the prevalence of SH was 9.1% among 1,020 hypertensive patients. In 76 (82%) of 93 patients with SH, hypertension was cured or improved after unilateral adrenalectomy, transsphenoidal pituitary adenectomy or percutaneous transluminal angioplasty. With the exception of US and CT, all initial and secondary screening tests were found to be sensitive and specific for differentiating SH from essential hypertension (EH). In conclusion, the measurement of various hormone concentrations was very sensitive for ruling out SH--a condition for which, in the present study, there were few specific signs or symptoms--while CT and US examinations were not always useful for differentiating SH from EH. The prevalence of curable SH among hypertensive subjects was higher in this study, which was conducted by our simple method of screening tests, than in previous reports. Hypertensive patients should be screened for SH and the underlying disease treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complications.

High Prevalence of Secondary Hypertension and Insulin Resistance in Patients with Refractory Hypertension

Objective: To determine causes of treatment resistance in patients with refractory hypertension, and to estimate the prevalence of true resistant hypertension. Methods: We studied 50 consecutive patients referred with refractory hypertension after exclusion of hypokalemia and stenosis of the renal artery. Ambulatory blood pressure monitoring was performed in all patients to detect white-coat effect. The patients were hospitalized, antihypertensive drugs were withdrawn and a screening for secondary hypertension was performed. In addition, these patients, and a control group of essential hypertensives controlled with three antihypertensive drugs, underwent a OGTT with 75 g of glucose. Results: Primary normokaliemic hyperaldosteronism was diagnosed in seven patients. Two patients had a pheochromocytoma and six had white-coat effect. The 35 remaining patients with true resistant hypertension shown significant differences in serum insulin and HOMA IR when compared with the control group. Conclusions: These findings show that among normokaliemic treatment-resistant hypertension, the presence of hyperaldosteronism and pheochromocitoma is quite high. Moreover, treatment resistance in hypertensive patients appears to be associated with insulin resistance.

Prevalence of secondary hypertension in a southeastern US hypertension referral center

Prevalence of secondary hypertension in a southeastern US hypertension referral center

Prevalence of secondary hypertension and unusual aspects of the treatment of hypertension in elderly individuals

Although hypertension is very common in elderly subjects, there is little Published evidence on the effects of age on the Prevalence of ”secondary“ hypertension. Data derived from 2,880 untreated hypertensive subjects are Presented, showing that with increasing age from 70 years, the Prevalence of orthostatic hypertension falls from 17 to 4% while that of Primary aldosteronism, Cushing's syndrome and Pheochromocytoma changes very little and the Prevalence of hypertension due to hypothyroidism, renovascular stenosis and renal insufficiency increases Progressively, so that almost 10% of hypertensive Patients older than 60 years had renovascular hypertension or renal insufficiency. The SHEP study has shown that treatment of hypertension in the elderly significantly reduced cardiovascular but not total mortality. In secondary hypertension, specific, pathogenesis-related therapy is recommended and often effective. In elderly Patients with Primary hypertension, therapeutic decisions are influenced by the need to minimize side effects (such as orthostatic hypotension), the desirability of avoiding excessive reduction in (especially) diastolic Pressures, and the Possibility that in some situations treatment may actually reduce life expectancy.

Prevalence of Secondary Hypertension in the Hypertension Detection and Follow-up Program

Elsewhere in this issue, Lewin and his colleagues have attempted to estimate the prevalence of potentially curable hypertension among the Hypertension Detection and Follow-up Program (HDFP) population. 1 The multicentric study, which was not designed for this purpose, used an algorithm for evaluating patients for secondary hypertension based on information commonly accepted when the study was designed 15 years ago. Since the decision to pursue an evaluation for secondary hypertension was left to the judgment of the specific investigator, fewer than half of the 146 HDFP patients judged to have poorly controlled hypertension, a population in which one would expect the prevalence of secondary forms of hypertension to be increased, were evaluated. Nonetheless, the study confirms the generally held impression that secondary forms of hypertension are less common among patients with mild or moderate levels of hypertension than in those in whom hypertension is accelerated or when a population of older

Secondary hypertension in a medical ward.

The prevalence of secondary hypertension was evaluated by investigating 400 consecutive patients with arterial hypertension in a medical ward. They were classified into four groups according to the case history. Group A: 104 subjects with therapy-resistant hypertension, group B: 247 patients who had another concomitant disease as the primary reason for admission, group C: 34 patients referred to the ward for basic investigation due to recently diagnosed hypertension, group D: 15 patients with unwanted hypertension was 15.5% in the entire series, and 14.4%, 18.6%, 2.9% and 0% in groups A - D, respectively. Ten patients (2.5%) were operated on, nine of them from group A and one from group B. The findings demonstrate the importance of a careful examination of patients with therapy-resistant hypertension, since they might include subjects whose hypertension can be treated by surgery.

Pre-treatment workup for antihypertensive treatment.

The prevalence of primary and secondary hypertension and of heart and kidney involvement was thoroughly studied in 689 hypertensive subjects derived from a blood pressure screening examination of a total population sample of Swedish men (n = 7,452). The prevalence of secondary hypertension was found to be only 5%, the prevalence of surgically curable hypertension being even lower. Left ventricular hypertrophy and slight heart enlargement were each found in about one-third of the hypertensive patients, while severe heart enlargement, left ventricular hypertrophy on ECG, proteinuria, abnormal serum creatinine and urinary sediment were each found in about 5%. On the basis of these findings, a minimum pre-treatment workup in uncomplicated hypertension is proposed.