From the Guidelines
The most common cause of secondary hypertension in an 18-year-old is not explicitly stated in the provided evidence, but based on the available data, renal parenchymal disease is a common cause of secondary hypertension, with a prevalence of 1%–2% in the general population, as reported in 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. To diagnose renal parenchymal disease, a doctor would typically order:
- Renal ultrasound
- Tests to evaluate the cause of renal disease, such as urinalysis and serum creatinine levels If confirmed, treatment options include:
- Medications to control blood pressure and slow the progression of kidney disease
- Lifestyle modifications, such as dietary changes and increased physical activity It's crucial to identify and treat this condition early, as it can lead to kidney damage and resistant hypertension if left untreated. The 2020 international society of hypertension global hypertension practice guidelines emphasize the importance of early diagnosis and targeted treatment of secondary hypertension, which can potentially cure hypertension or improve blood pressure control and reduce the number of prescribed antihypertensive medications 1. Some key points to consider when evaluating secondary hypertension in an 18-year-old include:
- Clinical indications, such as urinary tract infections, obstruction, hematuria, and urinary frequency and nocturia
- Physical examination findings, such as abdominal mass or skin pallor
- Screening tests, such as renal ultrasound and urinalysis
- Confirmatory tests, such as tests to evaluate the cause of renal disease By considering these factors and using the latest evidence-based guidelines, healthcare providers can make informed decisions about the diagnosis and treatment of secondary hypertension in young adults.
From the Research
Secondary Hypertension Causes
The most common causes of secondary hypertension vary by age. In children and young adults, the most common causes include:
- Renal parenchymal disease
- Coarctation of the aorta 2, 3 For an 18-year-old, the presence of hypertension at a young age may suggest coarctation of the aorta, fibromuscular dysplasia, or an endocrine disorder 2.
Endocrine Causes
Endocrine causes of secondary hypertension include:
- Primary hyperaldosteronism
- Pheochromocytoma
- Cushing's syndrome
- Hyperthyroidism
- Hyperparathyroidism 2, 4, 5, 3
Other Causes
Other causes of secondary hypertension include:
- Renovascular disease
- Renal parenchymal disease
- Obstructive sleep apnea
- Drug and substance use
- Congenital adrenal hyperplasia
- Aortic coarctation 5, 3, 6 It is essential to note that the evaluation of secondary hypertension should be based on specific criteria, including the presence of signs suggesting a specific secondary cause, and should not be conducted for all patients with hypertension 2, 4.