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Journal of Clinical Hypertension... Jul 2008
Topics: Humans; Hypertension; Risk Factors
PubMed: 18607137
DOI: 10.1111/j.1751-7176.2008.08088.x -
American Family Physician Jan 2003Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Only about 5 to 10 percent of hypertension... (Review)
Review
Secondary hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Only about 5 to 10 percent of hypertension cases are thought to result from secondary causes. The ABCDE mnemonic can be used to help determine a secondary cause of hypertension: Accuracy of diagnosis, obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, excess Erythropoietin, and Endocrine disorders. An algorithm showing the general strategy to help screen for factors involved in secondary hypertension is presented. Routine urinalysis, complete blood cell count, blood chemistry profile (potassium, sodium, creatinine, fasting glucose, fasting lipid levels), and a 12-lead electrocardiogram are recommended for all patients with hypertension.
Topics: Blood Pressure Determination; Critical Pathways; Diagnosis, Differential; Diagnostic Tests, Routine; Humans; Hypertension; Risk Factors
PubMed: 12537168
DOI: No ID Found -
Journal of Clinical Hypertension... Jul 2008The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic... (Review)
Review
The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, beta-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals.
Topics: Antihypertensive Agents; Bariatric Surgery; Blood Pressure; Drug Therapy, Combination; Hemodynamics; Humans; Hypertension; Leptin; Metabolic Syndrome; Obesity; Renin-Angiotensin System; Risk Reduction Behavior; Sympathetic Nervous System; Weight Loss
PubMed: 18607142
DOI: 10.1111/j.1751-7176.2008.08178.x -
Reviews in Cardiovascular Medicine Dec 2020Screening for secondary hypertension (HTN) is recommended for early-onset HTN. However, there have been few studies on secondary HTN in young adults. We aimed to...
Screening for secondary hypertension (HTN) is recommended for early-onset HTN. However, there have been few studies on secondary HTN in young adults. We aimed to investigate the prevalence and risk factors for secondary HTN in young male military personnel. In this retrospective cross-sectional study, hypertensive men (age, 19-29 years) were identified using the electronic medical records (EMR) database between 2011 and 2017. Among them, patients with secondary HTN were confirmed through a review of the EMR. Using clinical characteristics and laboratory findings, independent predictors associated with secondary HTN were identified by binary logistic regression analysis. Secondary HTN was confirmed in 140 of 6373 participants (2.2%). Overall, the most common causes were polycystic kidney disease (n = 47, 0.74%) and renal parenchymal diseases (n = 24, 0.38%). The independent predictors of secondary HTN were abnormal thyroid function test (TFT) (odds ratio [OR]: 9.50, 95% confidence interval [CI]: 4.84-19.45, P < 0.001), proteinuria (≥ trace) (OR: 6.13, 95% CI: 2.97-12.99, P < 0.001), hematuria (≥ trace) (OR: 4.37, 95% CI: 2.15-9.01, P < 0.001), severe HTN (≥ 180/110 mmHg) (OR: 3.07, 95% CI: 1.42-6.65, P = 0.004), and non-overweight (OR: 3.03, 95% CI: 1.69-5.26, P < 0.001). However, there were no significant differences in the family history of HTN, headache, total cholesterol, and diabetes between patients with primary and secondary HTN. Therefore, to ensure cost-effectiveness, screening for secondary HTN in young hypertensive men should be performed selectively considering abnormal TFT, proteinuria, hematuria, severe HTN, and non-overweight.
Topics: Age Factors; Cross-Sectional Studies; Databases, Factual; Humans; Hypertension; Male; Military Health; Prevalence; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Young Adult
PubMed: 33388008
DOI: 10.31083/j.rcm.2020.04.121 -
International Journal of Molecular... Mar 2023Aldosterone, a vital hormone of the human body, has various pathophysiological roles. The excess of aldosterone, also known as primary aldosteronism, is the most common... (Review)
Review
Aldosterone, a vital hormone of the human body, has various pathophysiological roles. The excess of aldosterone, also known as primary aldosteronism, is the most common secondary cause of hypertension. Primary aldosteronism is associated with an increased risk of cardiovascular disease and kidney dysfunction compared to essential hypertension. Excess aldosterone can lead to harmful metabolic and other pathophysiological alterations, as well as cause inflammatory, oxidative, and fibrotic effects in the heart, kidney, and blood vessels. These alterations can result in coronary artery disease, including ischemia and myocardial infarction, left ventricular hypertrophy, heart failure, arterial fibrillation, intracarotid intima thickening, cerebrovascular disease, and chronic kidney disease. Thus, aldosterone affects several tissues, especially in the cardiovascular system, and the metabolic and pathophysiological alterations are related to severe diseases. Therefore, understanding the effects of aldosterone on the body is important for health maintenance in hypertensive patients. In this review, we focus on currently available evidence regarding the role of aldosterone in alterations of the cardiovascular and renal systems. We also describe the risk of cardiovascular events and renal dysfunction in hyperaldosteronism.
Topics: Humans; Aldosterone; Cardiovascular Diseases; Hypertension; Hyperaldosteronism; Essential Hypertension
PubMed: 36982445
DOI: 10.3390/ijms24065370 -
Journal of Clinical Hypertension... Dec 2018Spectral Doppler ultrasonography provides the evaluation of renal resistive index (RRI), a noninvasive and reproducible measure to investigate arterial compliance and/or... (Review)
Review
Spectral Doppler ultrasonography provides the evaluation of renal resistive index (RRI), a noninvasive and reproducible measure to investigate arterial compliance and/or resistance. RRI seems to possess an important role in the evaluation of diverse cases of secondary hypertension. In essential hypertension, RRI is associated with subclinical markers of target organ damage and reflects renal disease progression beyond albuminuria and creatinine clearance. Also, RRI can estimate cardiovascular and renal risk. The evaluation of RRI may also help the therapeutic decisions. Given its simple assessment, RRI emerges as a simple method and a "multifunctional" tool that could help on the cardiovascular risk evaluation of the hypertensive patient.
Topics: Albuminuria; Blood Pressure; Cardiovascular Diseases; Clinical Decision-Making; Creatinine; Disease Progression; Female; Hemodynamics; Humans; Hypertension; Kidney; Kidney Diseases; Male; Risk Factors; Ultrasonography, Doppler; Vascular Resistance
PubMed: 30362245
DOI: 10.1111/jch.13410 -
Pediatric Clinics of North America Feb 2014Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative... (Review)
Review
Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative percentiles that factor in age, sex and height. Evaluation is more similar to adult essential hypertension than childhood secondary hypertension. Modifiable risk factors such as obesity, sodium consumption and low exercise should be addressed first. Many anti-hypertensive medications now have specific regulatory approval for children. Sports participation need not be limited in mild or well-controlled cases. Primary care physicians play an important role in reduction of cardiovascular mortality by early detection and referral when needed.
Topics: Adolescent; Antihypertensive Agents; Blood Pressure Determination; Child; Humans; Hypertension; Risk Factors
PubMed: 24267462
DOI: 10.1016/j.pcl.2013.09.011 -
Clinical Journal of the American... Mar 2017Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ... (Review)
Review
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events.
Topics: Antihypertensive Agents; Coronary Vasospasm; Diet; Diuretics; Drug Therapy, Combination; Electric Stimulation Therapy; Humans; Hypertension; Life Style; Mineralocorticoid Receptor Antagonists; Patient Compliance; Renal Insufficiency, Chronic; Sympathectomy
PubMed: 27895136
DOI: 10.2215/CJN.06180616 -
Annals of Agricultural and... Jun 2021Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular...
INTRODUCTION
Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular system. High blood pressure is the major modifiable cardiovascular risk factor.
OBJECTIVE
The aim of the study was assessment of the frequency of occurrence of cardiovascular risk factors, with particular consideration of arterial blood pressure.
MATERIAL AND METHODS
The study was conducted among 509 volunteers from Lublin in eastern Poland who participated in the prophylactic programme entitled 'White Sunday'. Standard measurements of blood pressure were performed using a TM-Z dial pressure gauge. The level of arterial blood pressure and socio-demographic parameters were analyzed.
RESULTS
Hypertension was more frequently observed in the group of males than females. The age group especially vulnerable to abnormal blood pressure values were those aged 51-60. Isolated hypertension significantly more often occurred in the group of respondents who mentioned hypertension in an interview, compared to those who reported its absence. Among 367 persons who, in preliminary interview, did not declare hypertension, 60 cases of isolated arterial hypertension were noted (16.3%). From among respondents who declared absence of hypertension in an interview, the largest age group diagnosed with isolated arterial hypertension were those aged 61-70 (17.9%).
CONCLUSIONS
Arterial hypertension is a civilisation disease which may be effectively prevented, simultaneously reducing the risk of premature death due to cardiovascular events, as well as reducing social and economic costs. International health organizations recommend the implementation of social screening programmes in order to diagnose high blood pressure and the promotion of routine measurements of arterial blood pressure.
Topics: Adult; Age Distribution; Aged; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged; Poland
PubMed: 34184517
DOI: 10.26444/aaem/134221 -
International Journal of Molecular... Apr 2022Primary aldosteronism (PA) is a pathological condition characterized by an excessive aldosterone secretion; once thought to be rare, PA is now recognized as the most... (Review)
Review
Primary aldosteronism (PA) is a pathological condition characterized by an excessive aldosterone secretion; once thought to be rare, PA is now recognized as the most common cause of secondary hypertension. Its prevalence increases with the severity of hypertension, reaching up to 29.1% in patients with resistant hypertension (RH). Both PA and RH are "high-risk phenotypes", associated with increased cardiovascular morbidity and mortality compared to non-PA and non-RH patients. Aldosterone excess, as occurs in PA, can contribute to the development of a RH phenotype through several mechanisms. First, inappropriate aldosterone levels with respect to the hydro-electrolytic status of the individual can cause salt retention and volume expansion by inducing sodium and water reabsorption in the kidney. Moreover, a growing body of evidence has highlighted the detrimental consequences of "non-classical" effects of aldosterone in several target tissues. Aldosterone-induced vascular remodeling, sympathetic overactivity, insulin resistance, and adipose tissue dysfunction can further contribute to the worsening of arterial hypertension and to the development of drug-resistance. In addition, the pro-oxidative, pro-fibrotic, and pro-inflammatory effects of aldosterone may aggravate end-organ damage, thereby perpetuating a vicious cycle that eventually leads to a more severe hypertensive phenotype. Finally, neither the pathophysiological mechanisms mediating aldosterone-driven blood pressure rise, nor those mediating aldosterone-driven end-organ damage, are specifically blocked by standard first-line anti-hypertensive drugs, which might further account for the drug-resistant phenotype that frequently characterizes PA patients.
Topics: Aldosterone; Fibrosis; Humans; Hyperaldosteronism; Hypertension; Kidney
PubMed: 35563192
DOI: 10.3390/ijms23094803