From the Guidelines
The most common cause of secondary hypertension in an 18-year-old is likely renal parenchymal disease, given the prevalence of such conditions in the general population with secondary hypertension. According to the 2020 international society of hypertension global hypertension practice guidelines 1, renal parenchymal disease is one of the most common types of secondary hypertension in adults, which can be applicable to young adults as well. This includes conditions like glomerulonephritis, polycystic kidney disease, and renal artery stenosis.
Key Considerations
- In young adults, renovascular hypertension is particularly significant, with fibromuscular dysplasia being more common than atherosclerotic disease in this age group, as suggested by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
- Other important causes to consider include endocrine disorders such as primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma, and thyroid disorders.
- Coarctation of the aorta is a congenital cardiovascular cause that may not be diagnosed until adolescence or early adulthood.
Diagnostic Approach
When evaluating an 18-year-old with hypertension, a thorough history, physical examination, and targeted laboratory testing are essential, including:
- Urinalysis
- Renal function tests
- Electrolyte panels Imaging studies like renal ultrasound or CT angiography may be necessary depending on clinical suspicion. Early identification of secondary hypertension is crucial as treating the underlying cause can potentially cure the hypertension and prevent long-term complications, as emphasized by 1.
From the Research
Secondary Hypertension in 18-Year-Olds
The most common causes of secondary hypertension vary by age. In children and young adults, the common causes are:
- Renal parenchymal disease
- Coarctation of the aorta 2
Common Causes of Secondary Hypertension
Other underlying causes of secondary hypertension include:
- Hyperaldosteronism
- Obstructive sleep apnea
- Pheochromocytoma
- Cushing syndrome
- Thyroid disease
- Coarctation of the aorta
- Use of certain medications 2
- Renovascular hypertension 3, 4
- Chronic kidney disease 5
- Primary aldosteronism 5
Diagnosis and Treatment
Diagnosis of secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years, malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings 2. Screening for renal artery stenosis can be done with Doppler ultrasonography, CT angiography, and magnetic resonance angiography 4, 6.