Document Detail

Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence.
MedLine Citation:
PMID:  20361196     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hypertensive urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available.
METHODS: Patients presenting to the emergency room for over 1 year with systolic blood pressure > or =180 mmHg and/or diastolic blood pressure > or =100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after > or =2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed.
RESULTS: Of 161 patients (age, 66.0 +/- 13.1 years; BMI, 28.6 +/- 5.1 kg), 131 had previously identified hypertension (duration, 12.7 +/- 11.5 years; 1.9 +/- 1.5 antihypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5-15/h), 26.8% moderate (15.1-30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), > or =2 in 25 (15.5%), and > or =1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously.
CONCLUSIONS: Secondary causes of hypertension are common and predominantly unrecognized in patients with hypertensive urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.
Jan Börgel; Stephanie Springer; Jasmin Ghafoor; Daniel Arndt; Hans-Werner Duchna; Andreas Barthel; Sibylle Werner; Josef Van Helden; Christoph Hanefeld; Horst Neubauer; Daniel Bulut; Andreas Mügge
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Publication Detail:
Type:  Journal Article     Date:  2010-04-02
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  99     ISSN:  1861-0692     ISO Abbreviation:  Clin Res Cardiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-29     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  499-506     Citation Subset:  IM    
Department of Cardiology and Angiology, University Clinic St. Josef Hospital, Heart Center, University of Bochum, Germany.
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MeSH Terms
Emergency Service, Hospital / statistics & numerical data*
False Positive Reactions
Germany / epidemiology
Hyperaldosteronism / diagnosis,  epidemiology*
Hypertension / diagnosis,  epidemiology*
Renal Artery Obstruction / diagnosis,  epidemiology*
Risk Assessment
Risk Factors
Sleep Apnea Syndromes / diagnosis,  epidemiology*

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