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Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence

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Abstract

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 ≥180 mmHg and/or diastolic blood pressure ≥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 ≥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%), ≥2 in 25 (15.5%), and ≥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.

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Conflict of interest statement

The authors state that there are no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, University Clinic St. Josef Hospital, Heart Center, University of Bochum, Gudrun Str. 56, 44791, Bochum, Germany

    Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Christoph Hanefeld, Horst Neubauer, Daniel Bulut & Andreas Mügge

  2. Department of Pneumology, University Clinic Bergmannsheil, University of Bochum, Bochum, Germany

    Hans-Werner Duchna

  3. Endokrinologikum Ruhr, Bochum, Germany

    Andreas Barthel

  4. Department of Medicine III, Technische Universität Dresden, Dresden, Germany

    Andreas Barthel

  5. Institute for Microbiology, University of Bochum, Bochum, Germany

    Sibylle Werner

  6. Labor Stein and Partners, Mönchen-Gladbach, Germany

    Josef Van Helden

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  1. Jan Börgel
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  2. Stephanie Springer
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  3. Jasmin Ghafoor
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Correspondence to Jan Börgel.

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Börgel, J., Springer, S., Ghafoor, J. et al. Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence. Clin Res Cardiol 99, 499–506 (2010). https://doi.org/10.1007/s00392-010-0148-4

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  • DOI: https://doi.org/10.1007/s00392-010-0148-4

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