Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyDecember 2024
Patients in their 30s had higher rates of secondary hypertension than did younger adults, which highlights potential gaps in screening recommendations.
The prevalence of secondary causes of hypertension varies depending on the studied population. Data suggest that 10% of adults with hypertension have secondary causes, although this percentage is probably an underestimate. Current American College of Cardiology/American Heart Association guidelines recommend screening for secondary causes of hypertension in patients who are younger than 30 (NEJM JW Gen Med 15 Dec 2017 and J Am Coll Cardiol 2018; 71: e127-e248). In this cross sectional study, investigators aimed to characterise the prevalence of secondary causes in 2000 young adults (age, 18 to 40 years) with confirmed hypertension who were seen in French hypertension referral centres.
Key findings were as follows:
- secondary hypertension was noted in 30% of patients overall. Notably, patients who were 30 to 40 years old were more likely to have secondary causes than were those who were 18 to 30 years old
- secondary hypertension was more common in women, patients with body mass index 25kg/m2 or lower, and those with diabetes
- among patients with secondary causes, more than half had primary aldosteronism, and 20% had renovascular hypertension.
Comment: Secondary causes for hypertension, particularly primary aldosteronism, remain underdiagnosed. In part, this is because current screening strategies that employ aldosterone-to-renin ratios can be challenging to interpret (NEJM JW Gen Med 1 Jun 2023 and J Clin Endocrinol Metab 2023; 108: 1143-1153) and have variable sensitivity (NEJM JW Gen Med 15 Sep 2021 and J Clin Endocrinol Metab 2021; 106: 2423-2435). Nonetheless, early detection is critical, as many secondary causes have targeted treatments that are different from standard first-line therapies. We should broaden our thinking about which patients should be screened to ensure that secondary hypertension is identified and treated promptly in patients at risk.
Jennifer L. Cluett, MD, Assistant Professor of Medicine, Harvard Medical School, Boston, USA
de Freminville J-B, et al. Prevalence and risk factors for secondary hypertension in young adults. Hypertension 2024; 81: 2340-2349.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Cardiology.