In an article published in the BMJ: ‘Investigating hypertension in younger patients’, Doctors Stuart Rison, Chris Carvalho and John Robson of Queen Mary’s Clinical Effectiveness Group (CEG) argue that GPs should be mindful of the possibility of an underlying condition when treating patients with hypertension who are under 40 years old and investigate this as appropriate.
Up to 30% of cases of persistently high blood pressure in young adults may be caused by an underlying condition – this is known as secondary hypertension. Distinguishing between early onset hypertension with or without an underlying cause is important because the diagnoses may require different treatment, and sometimes treating an underlying condition can be curative.
There is often a significant delay before secondary hypertension is diagnosed: typically two to four years, but sometimes decades. During that time, the underlying condition goes untreated and some patients may remain at risk from heart disease unnecessarily.
“Identifying and appropriately treating secondary hypertension early can have a hugely beneficial impact on a person's health. A young patient with hypertension has more ‘at risk’ years of damage from high blood pressure than patients in whom hypertension develops later, and some underlying conditions associated with secondary hypertension also have their own health consequences if left untreated.
“Essential hypertension (without a cause) remains the most common reason for high blood pressure, even in younger patients, but hypertension with an underlying pathological cause still accounts for 5% to 30% of cases in people under 40 and this warrants investigation.”
The authors cite a recent study of 20,000 patient pairs, which found that people whose hypertension started before the age of 45 died at twice the rate of patients diagnosed with hypertension at 65 or older, suggesting a significant shortening of life for those with early onset hypertension.
Dr Rison and his collaborators have set out a suggested framework for investigating the most common conditions that cause high blood pressure in young adults, including thyroid dysfunction, renal parenchymal disease and renal artery stenosis secondary to fibromuscular dysplasia. Early treatment of those conditions may prevent irreversible health damage from persistent high blood pressure, meaning younger patients are likely to have better outcomes.