Clinical spectrum of young hypertensive patients in north India: A hospital-based prospective observational study

ABSTRACT Introduction: Hypertension is increasingly prevalent among young adults in India, with secondary causes playing a significant role in this demographic. Early recognition of the etiological and clinical spectrum is crucial for timely diagnosis and effective management. Objectives: To evaluate the clinical characteristics, etiological patterns, and biochemical profiles of young hypertensive patients, with focus on secondary hypertension and ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) profiles. Materials and Methods: This was a cross-sectional, observational study conducted in a tertiary care hospital in North India, involving 239 hypertensive patients aged 18–40 years. Data on demographics, clinical staging, body mass index (BMI), metabolic syndrome, lipid profiles, drug usage, target organ damage, and ABPM/HBPM were collected. Statistical analysis was performed using Chi-square and P values, with significance set at P < 0.05. Results: Of the 239 patients, 77.8% had primary and 22.2% had secondary hypertension. Secondary hypertension was significantly more common in younger age groups ( P = 0.0005), and was associated with a higher requirement for multiple antihypertensive agents ( P = 0.0005) and increased risk of target organ damage ( P = 0.0005). Metabolic syndrome was significantly associated with higher BMI categories ( P = 0.0001), as were parameters of dyslipidemia. Renal parenchymal disease (41.5%) was the most common secondary cause, followed by endocrine and renovascular disorders. ABPM revealed abnormal dipping patterns in over 50% of patients, with non-dipping status significantly associated with secondary hypertension ( P = 0.0005). HBPM performed in the same cohort revealed white coat hypertension ( n = 14, 21.5%) while masked hypertension was seen in 22 subjects (33.8%), in accordance with ABPM data. (κ = 0.82, P < 0.001). Conclusion: Secondary hypertension represents a substantial burden among young hypertensives and is often accompanied by greater disease severity, target organ damage, and ABPM/HBPM abnormalities. Comprehensive evaluation, including etiological screening and biochemical profile, should be emphasized in the diagnostic workup of young hypertensive individuals to optimize outcomes and prevent long-term complications.