Kotliar Carol, Obregón Sebastián, Koretzky Martin, Botto Fernando, Di Leva Ana, Boscaro Marcelo, Ali Ayan, Ferdinand Keith C
Center of Hypertension, Austral University Hospital, Buenos Aires, Argentina.
Santa María de la Salud, Center for the Prevention of Hypertension, Dyslipidemia and Diabetes, San Isidro, Buenos Aires, Argentina.
Ann Transl Med. 2018 Aug;6(15):293. doi: 10.21037/atm.2018.06.25.
The accurate identification and diagnosis of secondary hypertension is critical, especially while atherosclerotic cardiovascular heart disease continues to be the leading cause of death in the industrialized world. Nevertheless, despite the existence of diagnostic tools, there are significant variations of the estimated prevalence of secondary hypertension, due to multiple etiologies and suboptimal recognition. This study demonstrates the results of using a systematic and protocolled approach to improve recognition of the presence of secondary hypertension. In the future, this questionnaire can be a quick and effective tool to unveil secondary hypertension in a broad array of clinical settings.
A total of 28,633 consecutive patients from January 1, 2007 to January 1, 2017 were diagnosed as having primary or secondary hypertension, utilizing the International Code of Diseases. Patients were located at the Center of Hypertension, Institute of Cardiology at Austral University Hospital, Buenos Aires, Argentina and were then further classified as having TRH, or non-resistant hypertension, to which a systematic protocol was employed in search for secondary hypertension. The confirmation of secondary hypertension was subsequently confirmed by diagnostic laboratory and imaging techniques in a hospital setting.
A final population of 12,284 patients with treatment resistant hypertension (TRH) and non-treatment resistant hypertension (NTRH) were included in this study, where an etiology of secondary hypertension was identified in 50.9% and 36% of patients in each treatment group, respectively. Physicians used confirmatory laboratory testing and imaging of patients who were identified as having a cause for their secondary hypertension, with no significant differences in sex, age and body mass index (BMI) among study groups.
These results illustrate the prevalence and distribution of the causes of secondary hypertension using a systematic, protocolled approach, which revealed a higher percentage of secondary hypertension than previously reported. This tool may be used by healthcare providers to ensure the appropriate recognition of secondary causes of hypertension in a wider range of patients with high blood pressure beyond resistant hypertension, changing the diagnostic paradigm of this condition.
继发性高血压的准确识别和诊断至关重要，尤其是在动脉粥样硬化性心血管疾病仍是工业化国家主要死因的情况下。然而，尽管存在诊断工具，但由于多种病因和识别欠佳，继发性高血压的估计患病率仍存在显著差异。本研究展示了采用系统且标准化方法提高继发性高血压识别率的结果。未来，这份问卷可成为在广泛临床环境中揭示继发性高血压的快速有效工具。
利用国际疾病分类法，对2007年1月1日至2017年1月1日期间连续就诊的28,633例患者进行原发性或继发性高血压诊断。这些患者来自阿根廷布宜诺斯艾利斯澳大利亚大学医院心脏病学研究所高血压中心，随后被进一步分类为患有治疗抵抗性高血压（TRH）或非抵抗性高血压，针对TRH采用系统方案来寻找继发性高血压病因。继发性高血压随后在医院环境中通过诊断性实验室和影像学技术得以确诊。
本研究纳入了最终的12,284例治疗抵抗性高血压（TRH）和非治疗抵抗性高血压（NTRH）患者，每个治疗组中分别有50.9%和36%的患者被确定为继发性高血压病因。医生对被确定为有继发性高血压病因的患者进行了确证性实验室检测和影像学检查，各研究组在性别、年龄和体重指数（BMI）方面无显著差异。
这些结果说明了采用系统、标准化方法时继发性高血压病因的患病率和分布情况，显示出继发性高血压的比例高于先前报告。医疗保健提供者可使用此工具，以确保在更广泛的高血压患者（而非仅抵抗性高血压患者）中正确识别继发性高血压病因，从而改变这种疾病的诊断模式。
