From the Research
According to British guidelines, individuals under 50 years old with high blood pressure should be referred to a secondary hypertension clinic for investigation. This recommendation is based on the higher likelihood of secondary causes of hypertension in younger patients. Secondary hypertension refers to high blood pressure caused by an identifiable underlying condition, such as renal artery stenosis, pheochromocytoma, primary aldosteronism, or other endocrine disorders.
The initial evaluation should include a comprehensive medical history, physical examination, basic blood tests (including renal function, electrolytes, glucose, and lipid profile), urinalysis, and an ECG 1. While awaiting specialist assessment, appropriate antihypertensive therapy should be initiated based on the patient's age and comorbidities, typically starting with an ACE inhibitor or angiotensin receptor blocker for those under 55 years.
The specialist investigation may involve additional tests such as renal ultrasound, hormonal assays, or imaging studies depending on clinical suspicion 2. Early identification of secondary causes is crucial as treating the underlying condition may cure the hypertension or significantly improve blood pressure control, potentially reducing the need for lifelong medication and preventing complications.
Some studies suggest that renal ultrasound could be a useful tool in the initial evaluation of hypertensive patients, particularly in identifying common causes of secondary hypertension originating from the kidney 1, 2. However, the clinical relevance of renal resistive index (RRI) measurement as a surrogate endpoint of specific renal damage or/and as surrogate endpoint of atherosclerotic diffuse vascular damage is still debated 2.
In general, the management of hypertension in patients under 50 years old should prioritize the identification and treatment of secondary causes, as well as the initiation of appropriate antihypertensive therapy to reduce the risk of cardiovascular complications 3. Referral to a secondary hypertension clinic is essential for patients under 50 years old with high blood pressure, as it allows for a comprehensive evaluation and management of potential secondary causes of hypertension.