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Avesani M, Calcaterra G, Sabatino J, Pelaia G, Cattapan I, Barillà F, Martino F, Pedrinelli R, Bassareo PP, Di Salvo G. Pediatric Hypertension: A Condition That Matters. CHILDREN (BASEL, SWITZERLAND) 2024; 11:518. [PMID: 38790513 PMCID: PMC11120267 DOI: 10.3390/children11050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Systemic hypertension has been considered mainly as an adult health issue for a long time, but it is now being increasingly acknowledged as a significant problem also among pediatric patients. The frequency of pediatric hypertension has grown mostly because of increases in childhood obesity and sedentary lifestyles, but secondary forms of hypertension play a role as well. Considering that unaddressed hypertension during childhood can result in enduring cardiovascular complications, timely identification and intervention are essential. Strategies for addressing this disease encompass not only lifestyle adjustments, but also the use of medications when needed. Lifestyle modifications entail encouraging a nutritious diet, consistent physical activity, and the maintenance of a healthy weight. Moreover, educating both children and their caregivers about monitoring blood pressure at home can aid in long-term management. Thus, the aim of this review is to discuss the etiologies, classification, and principles of the treatment of hypertension in pediatric patients.
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Affiliation(s)
- Martina Avesani
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (M.A.); (I.C.)
| | | | - Jolanda Sabatino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (J.S.); (G.P.)
| | - Giulia Pelaia
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (J.S.); (G.P.)
| | - Irene Cattapan
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (M.A.); (I.C.)
| | - Francesco Barillà
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Francesco Martino
- Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, Sapienza University, 00185 Rome, Italy;
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital, D07 KH4C Dublin, Ireland;
| | - Giovanni Di Salvo
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (M.A.); (I.C.)
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İriz E, Tak S, Yiğiter EN, Leventoğlu E, Demirtaş H, Akkuzu E, Uysal Yazıcı M, Fidan K, Dalgıç A. A rare cause and an even rarer treatment of hypertension in a 5-year-old boy: Mid-aortic syndrome. Nephrology (Carlton) 2024; 29:230-234. [PMID: 38109884 DOI: 10.1111/nep.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid-aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non-surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5-year-old boy with a mid-aortic syndrome. The patient presented with a history of severe headache and epistaxis 5-6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast-enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.
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Affiliation(s)
- Erkan İriz
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Sercan Tak
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Eda Nur Yiğiter
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Hüseyin Demirtaş
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emine Akkuzu
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Kibriya Fidan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Aydın Dalgıç
- Faculty of Medicine, Department of General Surgery, Gazi University, Ankara, Turkey
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Awad L, Sethuraman U. Evaluation and Management of Elevated BP in Children in the ED. Curr Hypertens Rep 2024; 26:99-105. [PMID: 37975974 DOI: 10.1007/s11906-023-01283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW Pediatric hypertension has been on the rise over the past four decades. While most cases are evaluated and managed in the primary healthcare setting, some children may be referred to the emergency department (ED) for an expedited workup of elevated blood pressure or for management of hypertensive crisis. RECENT FINDINGS Acute severe hypertension without end-organ damage and hypertensive emergency are life-threatening conditions that healthcare providers must be prepared to accurately recognize and treat as pediatric hypertension increases in prevalence. In this article, we review the most recent definitions of elevated blood pressure and hypertension and discuss the updated literature on the evaluation and management of hypertension and hypertensive crisis of children in the ED.
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Affiliation(s)
- Lilian Awad
- Children's Hospital of Michigan, Detroit, MI, USA.
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Pike MM, Schildcrout J, Baldwin S, Edwards T, Lipworth L, Robinson‐Cohen C. Genetic Variants Associated With Systolic Blood Pressure in Children and Adolescents. J Am Heart Assoc 2023; 12:e027993. [PMID: 36718908 PMCID: PMC9973622 DOI: 10.1161/jaha.122.027993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
Background Genetics, along with lifestyle and behavioral characteristics, play an important role in hypertension in adults. Our aim was to identify genetic variants associated with blood pressure in childhood and adolescence. Methods and Results We conducted a candidate single-nucleotide polymorphism (SNP) analysis and genome-wide association study among 9778 participants aged <18 years in BioVU, the Vanderbilt University Medical Center biobank. The outcome was childhood blood pressure percentile from age 0 to 18 years. For the candidate SNP analysis, a total of 457 previously identified SNPs were examined. Linear regression was used to test the association between genetic variants and median systolic blood pressure (SBP) percentile. Adjusted models included median age, self-reported sex, race, the first 4 principal components of ancestry, and median body mass index Z score. Analyses were conducted in the overall cohort and stratified by age group. A polygenic risk score was calculated for each participant, and the association between polygenic risk score and median SBP percentile in childhood was examined using linear regression. In the overall candidate SNP analysis, 2 SNPs reached significance: rs1018148 (FBN1; P=1.0×10-4) and rs11105354 (ATP2B1; P=1.4×10-4). In the postpuberty age group, 1 SNP reached significance: rs1018148 (FBN1; P=2.2×10-5). In the genome-wide association study of all participants, no SNPs reached genome-wide significance. Higher polygenic risk score was associated with higher SBP percentile (β, 0.35 [95% CI, 0.10-0.60)], and there was a significant interaction with age (P for interaction<0.01). Conclusions These findings suggest that genetic variants play an important role in SBP in childhood and adolescence and provide evidence for age-specific genetic associations with SBP.
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Affiliation(s)
- Mindy M. Pike
- Division of Epidemiology, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | | | - Scott Baldwin
- Division of Pediatric Cardiology, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Todd Edwards
- Division of Epidemiology, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Loren Lipworth
- Division of Epidemiology, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Cassianne Robinson‐Cohen
- Division of Nephrology, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt‐O’Brien Center for Kidney DiseaseVanderbilt University Medical CenterNashvilleTNUSA
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Ghazi L, Annabathula RV, Bello NA, Zhou L, Stacey RB, Upadhya B. Hypertension Across a Woman's Life Cycle. Curr Hypertens Rep 2022; 24:723-733. [PMID: 36350493 PMCID: PMC9893311 DOI: 10.1007/s11906-022-01230-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW We reviewed the effects of hypertension and the means to prevent and treat it across the spectrum of a woman's lifespan and identified gaps in sex-specific mechanisms contributing to hypertension in women that need to be addressed. RECENT FINDINGS Hypertension continues to be an important public health problem for women across all life stages from adolescence through pregnancy, menopause, and older age. There remain racial, ethnic, and socioeconomic differences in hypertension rates not only overall but also between the sexes. Blood pressure cutoffs during pregnancy have not been updated to reflect the 2017 ACC/AHA changes due to a lack of data. Additionally, the mechanisms behind hypertension development in menopause, including sex hormones and genetic factors, are not well understood. In the setting of increasing inactivity and obesity, along with an aging population, hypertension rates are increasing in women. Screening and management of hypertension throughout a women's lifespan are necessary to reduce the burden of cardiovascular disease, and further research to understand sex-specific hypertension mechanisms is needed.
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Affiliation(s)
- Lama Ghazi
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
| | - Rahul V Annabathula
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Natalie A Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Li Zhou
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Richard Brandon Stacey
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157-1045, Winston-Salem, USA.
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Yang Y, Dai J, Min J, Wu H, Huang S, Li Q, Chai J. Prevalence trends of hypertension and influence factors among children and adolescents aged 7-17 years in China, 2011-2015: A serial cross-sectional study. Front Public Health 2022; 10:887285. [PMID: 36311569 PMCID: PMC9608369 DOI: 10.3389/fpubh.2022.887285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023] Open
Abstract
Hypertension has rapidly increased in the last decades throughout the world. It is an emerging disease. However, limited information is available on secular trends and factors of childhood and adolescents' hypertension in China. In this study, 5-year successive data were derived from a cross-sectional study of the China Health and Nutrition Survey (CHNS) in 2011 and 2015. We used systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) at least 95th percentile on the basis of age, sex, and height percentiles to define hypertension (HBP). A total of 2,827 children and adolescents aged 7-17 years were included. The age-standardized prevalence of hypertension was increased significantly across 5 years: the standardized prevalence of hypertension was increased from 8.08% (2011) to 11.46% (2015) in China (P < 0.01). The mean SBP of boys increased from 101.21 to 102.79 mmHg, while the mean SBP of girls increased from 98.96 to 100.04 mmHg. The mean DBP of boys increased from 61.20 to 67.40 mmHg, while the mean DBP of girls increased from 64.34 to 65.76 mmHg. The prevalence of hypertension grew continuously in both sexes, but the pace of change for boys was more rapid than that for girls. This study confirmed that the association between rural (odds ratio [OR] = 1.394, 95%CI 1.032-1.883), overweight/obesity (OR = 2.621, 95%CI 1.506-4.562), and BP levels was highly correlated (P < 0.05). The possible protecting factors associated with hypertension were being a girl (OR = 0.788, 95%CI 0.595-1.043). There was no association between weekly physical activity, daily sleep duration, and hypertension (P > 0.05). Further in-depth analysis of influencing factors and comprehensive interventions should be urgently implemented to combat the hypertension epidemic among children and adolescents in China.
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Affiliation(s)
- Yunjuan Yang
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China,Public Health School, Kunming Medical University, Kunming, China,Public Health School, Dali University, Dali, China,*Correspondence: Yunjuan Yang
| | - Jing Dai
- Management and Economy School, Kunming University of Science and Technology, Kunming, China
| | | | - Huamei Wu
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songquan Huang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingsheng Li
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Jiajia Chai
- Management and Economy School, Kunming University of Science and Technology, Kunming, China
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Antihypertensive Effects of IGTGIPGIW Peptide Purified from Hippocampus abdominalis: p-eNOS and p-AKT Stimulation in EA.hy926 Cells and Lowering of Blood Pressure in SHR Model. Mar Drugs 2022; 20:md20060354. [PMID: 35736156 PMCID: PMC9227393 DOI: 10.3390/md20060354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to assess the potential hypertensive effects of the IGTGIPGIW peptide purified from Hippocampus abdominalis alcalase hydrolysate (HA) for application in the functional food industry. We investigated the antihypertensive effects of IGTGIPGIW in vitro by assessing nitric oxide production in EA.hy926 endothelial cells, which is a major factor affecting vasorelaxation. The potential vasorelaxation effect was evaluated using 4-amino-5-methylamino-2′,7′-difluorofluorescein diacetate, a fluorescent stain. IGTGIPGIW significantly increased the expression of endothelial-derived relaxing factors, including endothelial nitric oxide synthase and protein kinase B, in EA.hy926 cells. Furthermore, oral administration of IGTGIPGIW significantly lowered the systolic blood pressure (183.60 ± 1.34 mmHg) and rapidly recovered the diastolic blood pressure (143.50 ± 5.55 mmHg) in the spontaneously hypertensive rat model in vivo. Our results demonstrate the antihypertensive activity of the IGTGIPGIW peptide purified from H. abdominalis and indicate its suitability for application in the functional food industry.
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Zhang Z, Zhang L, Sun L, Wang B, Yuan Y, Gao H, Fu L. Relative children's lipid accumulation with hypertension in Chinese children and adolescents. BMC Public Health 2021; 21:1884. [PMID: 34663277 PMCID: PMC8524786 DOI: 10.1186/s12889-021-11868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to develop a novel indicator associated with hypertension in Chinese children and adolescents, the relative children’s lipid accumulation product (RCLAP). Methods A cross-sectional study was conducted in 2018. A total of 683 students aged 8–15 years were recruited via a stratified cluster sampling Methods. Anthropometric indexes (waist circumference (WC), Body mass index (BMI), Waist-height ratio (WHtR), logarithm children LAP (LnCLAP), RCLAP per height (RCLAP-H)) were standardized using a z-score method (standardized variables: SWC, SBMI, SWHtR, SLnCLAP, SRCLAP-H). A logistic regression model was performed to evaluate the association of the above indicators with the outcome of hypertension. Results The overall prevalence of hypertension was 5.7% (5.5% in boys, 6.0% in girls). SWC ≥ P75, SBMI ≥ P75, SWHtR ≥ P75, SlnCLAP ≥ P75 and SRCLAP-H ≥ P75 significantly increased risk of hypertension, with odds ratios (OR) of 2.21 (95% confidence interval (CI): 1.13, 4.30), 2.30 (1.18, 4.49), 2.64 (1.35, 5.14), 4.43 (2.28, 8.61), and 4.49 (2.31, 8.71), respectively. Conclusion RCLAP is a novel indicator associated with hypertension in Chinese children and adolescents, and it performs better than WC, BMI, WHtR and children LAP.
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Affiliation(s)
- Zizhe Zhang
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China
| | - Li Zhang
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China
| | - Lili Sun
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China
| | - Bangxuan Wang
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China
| | - Yongting Yuan
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China
| | - Huaiquan Gao
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China.
| | - Lianguo Fu
- Department of child and adolescent health, School of public health, Bengbu Medical College, No. 2600 east sea avenue, Room 207, Bengbu, 233030, Anhui, China.
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Yang Z, Huang Y, Qin Y, Pang Y. Clinical Characteristics and Factors Associated With Hypertension in 205 Hospitalized Children: A Single-Center Study in Southwest China. Front Pediatr 2021; 9:620158. [PMID: 33898356 PMCID: PMC8058176 DOI: 10.3389/fped.2021.620158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to investigate the clinical characteristics and factors associated with pediatric hypertension and target organ damage (TOD). Methods: We retrospectively reviewed clinical data from 205 children with hypertension treated in our hospital from 2007 to 2018. The patients were classified based on the type of hypertension (primary, secondary) and presence of TOD (heart, brain, retina). Logistic regression analysis was performed to identify the factors independently associated with hypertension and TOD. Results: There were 107 males, 97 females, and one intersex in this study, with an age range of 0.1-17.9 years. Majority of cases (177, 86.3%) had secondary hypertension, while 13.7% had primary hypertension. The most frequent cause of secondary hypertension was renal disease (59.32%). Elevated serum creatinine level (odds ratio [OR] = 7.22, 95% confidence interval [95% CI] = 1.6-32.62, P = 0.01), blood urea nitrogen (OR = 6.33, 95% CI = 1.81-22.19, P = 0.004), serum uric acid level (OR = 3.66, 95% CI = 1.20-11.22, P = 0.023), and albuminuria (OR = 3.72, 95% CI = 1.50-9.26, P = 0.005) were independently associated with secondary hypertension. Elevated serum uric acid and blood urea nitrogen levels were associated with left ventricular hypertrophy (OR = 6.638, 95% CI = 1.349-32.657, P = 0.02) and hypertensive encephalopathy (OR = 4.384, 95% CI = 1.148-16.746, P = 0.031), respectively. Triglyceride level correlated with hypertensive retinopathy (P = 0.001). Conclusion: Pediatric hypertension was most often secondary, with renal disease as the leading cause. Elevated levels of serum uric acid, blood urea nitrogen, serum creatinine, and albuminuria may indicate secondary hypertension in childhood. Elevated serum uric acid, blood urea nitrogen, and triglyceride levels were associated with left ventricular hypertrophy, hypertensive encephalopathy, and hypertensive retinopathy, respectively.
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Affiliation(s)
- Zhiyong Yang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanyun Huang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Tziomalos K. Secondary Hypertension: Novel Insights. Curr Hypertens Rev 2019; 16:11. [PMID: 31038070 DOI: 10.2174/1573402115666190416161116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 01/15/2023]
Abstract
It is estimated that 5-10% of hypertensive patients have secondary hypertension. The main causes of secondary hypertension are parenchymal renal disease, primary aldosteronism and renovascular hypertension. The identification of these patients is important because it enables the etiological management of the underlying disease and in some cases leads to blood pressure control without antihypertensive medications. On the other hand, diagnostic evaluation for secondary hypertension often includes complex and expensive tests and should be performed only in patients with a strong clinical suspicion for its presence. If preliminary screening tests suggest the presence of secondary hypertension, these patients should be referred to specialized centers for further diagnostic evaluation and comprehensive management.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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