HIGH PREVALENCE OF SECONDARY ARTERIAL HYPERTENSION (HIPRESH) WITH PROSPECTIVE SYSTEMATIC SCREENING

Objective: Secondary arterial hypertension is generally held to be exceptionally rare, which translates into its detection only in selected cohorts of patients and thus in a vicious circle reinforcing this conception. The aim of the present study was to determine whether a systematic quest of secondary hypertension with improved diagnostic tools can unveil it in consecutive unselected hypertensive patients. Design and method: This prospective single-center cohort study started on January 1st 2017 and ended on January 31st 2023 in the Outpatient Clinic of our Specialized Hypertension Center. All patients were followed for an average of 1 year after the initial visit and targeted treatment. A total of 1375 consecutive patients attending the outpatient clinic were evaluated for eligibility. Exclusion criteria entailed known diagnosis of secondary hypertension, comorbidities rendering such diagnosis unfeasible or futile, or failure to complete the diagnostic workup. Secondary hypertension was systematically sought for in eligible patients by thorough history, physical examination, sleep questionnaires, and measurement of serum Na+, K+, ionized-Ca2+, plasma active renin (DRC), aldosterone concentration (PAC), PTH, TSH, and 24-h urinary/plasma Na+, K+, Ca2+, phosphate, metanephrine/normetanephrine excretion and renal Doppler-ultrasound assessment. Biochemical cure and/or prominent hemodynamic improvement after target treatment was used to confirm secondary hypertension. Results: Of 490 eligible patients (median age 62 years, 50% women), 83% had confirmed systo-diastolic hypertension and 17% isolated systolic hypertension. Secondary hypertension was found in 72% of the total cohort and 81.5% of those with systo-diastolic hypertension. It was due to primary aldosteronism (25.7%), obstructive sleep apnea (13.5%), hypothyroidism (8.0%), renovascular hypertension (6.5%) and a miscellanea of rarer causes (18.3%). Notably, 86% of the patients were self-presented and only 14% were referred by their doctors. Conclusions: Secondary hypertension is far more common than currently held. The small minority of the patients referred by their health care professionals highlights the poor appreciation of secondary hypertension, and indicates the need to increase awareness and broad screening strategies to identify the patients with curable hypertension.