What is the most common cause of secondary hypertension in an 18-year-old?

From the Guidelines

The most common cause of secondary hypertension in an 18-year-old is renal parenchymal disease, according to the most recent guidelines. This condition can lead to fluid retention, activation of the renin-angiotensin-aldosterone system, or increased sympathetic nervous system activity, ultimately resulting in high blood pressure 1.

Common Causes of Secondary Hypertension

• Renal parenchymal disease, including conditions like glomerulonephritis, polycystic kidney disease, and renal scarring from recurrent infections
• Renovascular causes, such as renal artery stenosis and fibromuscular dysplasia
• Endocrine disorders, including primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma, and thyroid dysfunction Evaluation should include a thorough history, physical examination, basic laboratory tests (complete blood count, comprehensive metabolic panel, urinalysis), and renal imaging 1.

Importance of Early Diagnosis

Early diagnosis of secondary hypertension and targeted treatment can potentially cure hypertension or improve blood pressure control and reduce the number of prescribed antihypertensive medications 1.

Treatment Approach

Treatment depends on the underlying cause but may include specific medications targeting the pathophysiology, such as ACE inhibitors or aldosterone antagonists, alongside addressing the primary condition. It is essential to prioritize the most recent and highest-quality study, which in this case is the 2020 international society of hypertension global hypertension practice guidelines 1.

From the Research

Causes of Secondary Hypertension

The most common causes of secondary hypertension vary by age. In children and young adults, the most common causes are:

• Renal parenchymal disease
• Coarctation of the aorta 2

Secondary Hypertension in Young Adults

For an 18-year-old, the most common causes of secondary hypertension would likely be related to renal or vascular issues, such as:

• Renal parenchymal disease
• Coarctation of the aorta
• Renovascular hypertension 2, 3, 4

Other Causes of Secondary Hypertension

Other potential causes of secondary hypertension include:

• Obstructive sleep apnea
• Primary aldosteronism
• Chronic kidney disease
• Pheochromocytoma
• Thyroid disease
• Certain medications 2, 5, 6