Approach to Major Secondary Causes of Hypertension in Young Adults: An Overlooked Condition
Poster #: 200
Session/Time: A
Author:
Juan Munoz Moreno, MD
Mentor:
Martha Gulati, MD, MS
Research Type: Review Article
Abstract
INTRODUCTION:
Arterial hypertension is a chronic cardiovascular condition with high global prevalence and significant impact on morbidity and mortality. Though common in older adults, it also affects young adults (19-40 years), with up to 10% of cases being secondary, often due to endocrine, renal, or cardiovascular causes. Early recognition and management can prevent complications such as left ventricular hypertrophy, coronary artery disease, heart failure, stroke, and peripheral arterial disease. However, it is frequently overlooked, delaying diagnosis and increasing the risk of target organ damage (TOD) and adverse cardiovascular outcomes. This review presents a diagnostic algorithm and summarizes specific treatments for the main secondary causes in young adults.
MAIN BODY:
The most frequent endocrine causes of secondary hypertension in young adults include primary aldosteronism, Cushing's syndrome, pheochromocytoma and paraganglioma, thyroid dysfunction, hyperparathyroidism, and acromegaly. Each presents with specific clinical and biochemical hallmarks, requiring targeted hormonal assays and imaging for diagnosis. Renal causes are equally important, particularly renovascular disease, with fibromuscular dysplasia being the predominant etiology in younger populations. Other renal contributors include chronic kidney disease, polycystic kidney disease, and juxtaglomerular cell tumors. Cardiovascular causes such as coarctation of the aorta must also be considered, especially when hypertension is detected at very young ages or in the presence of differential pulses and murmurs. Additional relevant etiologies are obstructive sleep apnea, oral contraceptive use, anticancer therapies, and even dietary habits, such as chronic licorice consumption. Screening for secondary hypertension is advised in young adults with resistant, severe (grade 2-3), abrupt-onset or rapidly worsening hypertension, hypertensive emergencies, disproportionate TOD, or clinical/biochemical features suggesting a secondary cause. Biochemical testing (e.g., plasma aldosterone-to-renin ratio, cortisol suppression tests, catecholamine metabolites, thyroid and parathyroid profiles), combined with imaging studies (CT, MRI, Doppler ultrasound, or echocardiography), play a central role. Early detection is essential, as several etiologies, including adrenal adenomas, renovascular lesions, and aortic coarctation, are amenable to curative surgical or interventional treatment. Therapeutic strategies must be individualized. Non-pharmacological interventions include adherence to the DASH diet, sodium restriction, weight reduction, smoking cessation, and regular aerobic exercise. Pharmacological therapy should be tailored according to etiology and comorbidities, with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide diuretics, and beta-blockers being the most widely used. In endocrine hypertension, specific interventions such as mineralocorticoid receptor antagonists, surgical resection of hormone-secreting tumors, or disease-targeted therapy significantly improve outcomes. In renal and cardiovascular causes, angioplasty, surgical repair, or renal transplantation may be required. Overall, a multidisciplinary approach is critical to achieving blood pressure control and preventing long-term complications.
CONCLUSION:
Secondary hypertension in young adults represents a clinically significant but frequently overlooked entity. Prompt recognition and systematic evaluation are essential for guiding appropriate therapy, reducing cardiovascular risk, and, in select cases, offering curative treatment. Raising awareness among clinicians regarding the diverse etiologies, tailored diagnostic strategies, and advances in management is fundamental to improving outcomes in this vulnerable population.
Arterial hypertension is a chronic cardiovascular condition with high global prevalence and significant impact on morbidity and mortality. Though common in older adults, it also affects young adults (19-40 years), with up to 10% of cases being secondary, often due to endocrine, renal, or cardiovascular causes. Early recognition and management can prevent complications such as left ventricular hypertrophy, coronary artery disease, heart failure, stroke, and peripheral arterial disease. However, it is frequently overlooked, delaying diagnosis and increasing the risk of target organ damage (TOD) and adverse cardiovascular outcomes. This review presents a diagnostic algorithm and summarizes specific treatments for the main secondary causes in young adults.
MAIN BODY:
The most frequent endocrine causes of secondary hypertension in young adults include primary aldosteronism, Cushing's syndrome, pheochromocytoma and paraganglioma, thyroid dysfunction, hyperparathyroidism, and acromegaly. Each presents with specific clinical and biochemical hallmarks, requiring targeted hormonal assays and imaging for diagnosis. Renal causes are equally important, particularly renovascular disease, with fibromuscular dysplasia being the predominant etiology in younger populations. Other renal contributors include chronic kidney disease, polycystic kidney disease, and juxtaglomerular cell tumors. Cardiovascular causes such as coarctation of the aorta must also be considered, especially when hypertension is detected at very young ages or in the presence of differential pulses and murmurs. Additional relevant etiologies are obstructive sleep apnea, oral contraceptive use, anticancer therapies, and even dietary habits, such as chronic licorice consumption. Screening for secondary hypertension is advised in young adults with resistant, severe (grade 2-3), abrupt-onset or rapidly worsening hypertension, hypertensive emergencies, disproportionate TOD, or clinical/biochemical features suggesting a secondary cause. Biochemical testing (e.g., plasma aldosterone-to-renin ratio, cortisol suppression tests, catecholamine metabolites, thyroid and parathyroid profiles), combined with imaging studies (CT, MRI, Doppler ultrasound, or echocardiography), play a central role. Early detection is essential, as several etiologies, including adrenal adenomas, renovascular lesions, and aortic coarctation, are amenable to curative surgical or interventional treatment. Therapeutic strategies must be individualized. Non-pharmacological interventions include adherence to the DASH diet, sodium restriction, weight reduction, smoking cessation, and regular aerobic exercise. Pharmacological therapy should be tailored according to etiology and comorbidities, with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide diuretics, and beta-blockers being the most widely used. In endocrine hypertension, specific interventions such as mineralocorticoid receptor antagonists, surgical resection of hormone-secreting tumors, or disease-targeted therapy significantly improve outcomes. In renal and cardiovascular causes, angioplasty, surgical repair, or renal transplantation may be required. Overall, a multidisciplinary approach is critical to achieving blood pressure control and preventing long-term complications.
CONCLUSION:
Secondary hypertension in young adults represents a clinically significant but frequently overlooked entity. Prompt recognition and systematic evaluation are essential for guiding appropriate therapy, reducing cardiovascular risk, and, in select cases, offering curative treatment. Raising awareness among clinicians regarding the diverse etiologies, tailored diagnostic strategies, and advances in management is fundamental to improving outcomes in this vulnerable population.