Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension

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Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension Gian Paolo Rossi1   · Valeria Bisogni1 · Giacomo Rossitto1 · Giuseppe Maiolino1 · Maurizio Cesari1 · Rui Zhu1 · Teresa Maria Seccia1 Received: 20 July 2020 / Accepted: 10 October 2020 © The Author(s) 2020

Abstract The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a ‘secondary’ form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing’s syndrome, and obstructive sleep apnea. Keywords  Primary aldosteronism · Renovascular hypertension · Pheochromocytoma/paraganglioma · Cushing’s syndrome · Obstructive sleep apnea

1 Introduction By definition ‘secondary’ hypertension (SH) comprises those forms of arterial hypertension (HT) that are due to an identified cause and, therefore, can be resolved by removing the underlying cause. The European Societies of Cardiology and Hypertension (ESC/ESH) guidelines suggest that the screening for SH should be restricted to patients with certain features, such as younger age (i.e.  150/100 mmHg on each of 3 measurements obtained on different days Hypertension (BP > 140/90 mmHg) resistant to 3 conventional antihypertensive drugs (including a diuretic) Spontaneous or diuretic-induced hypokalemia Hypertension and adrenal incidentaloma Obstructive sleep apnea Family history of primary aldosteronism and/or early-onset hypertension or cerebrovascular accident at a young age (< 40 years) Atrial fibrillation not explained by other causes (i.e. valvular disease) HMOD (i.e. LVH, diastolic dysfunction, microalbuminuria, CKD) in excess of what expect based on BP values BP blood pressure, HMOD hypertension-mediated organ damage, LVH left ventricular hypertrophy, CKD chronic kidney disease

with severe hypokalemia and/or poor control of BP values, because the MRAs are the most effective agents to control BP and hypokalemia in PA patients. The use of confirmatory tests