Inflation of diagnostic tests in hypertensive young adults: a need for diagnostic guideline?
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The cause of hypertension in young adults (age:18–29 years) is mostly a primary condition although secondary causes are frequent in this population. Clinical files of 100 patients were reviewed to evaluate the use of diagnostic tests after completion of diagnostic work-up for hypertension. Seventy-nine patients had primary hypertension while 21 patients had secondary hypertension. Renal imaging studies, serum levels of aldosterone and plasma renin activity, and screening tests for pheochromocytoma were more likely to be performed in patients younger than 24 years, in female patients and in patients without familial history of hypertension in primary hypertensive patients (p<0.05). Renal imaging studies and screening tests for pheochromocytoma were done more frequently in patients with Stage 2 hypertension (p<0,05). Among secondary hypertensives, renal imaging studies and renal biopsy were more ordered in patients younger than 24 years, in female patients, in patients with Stage 2 hypertension and in patients without family history for hypertension (p<0.05). Mean body mass index was higher in patients with primary hypertension than patients with secondary hypertension (p<0.05). Seventy patients (70%) had undergone several screening interventions with negative results. In conclusion, a simple, stepwise diagnostic evaluation would greatly benefit the management of young hypertensives.
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-  Lurbe E., Torro I., Alvarez V., Nawrot T., Paya R., Redon J., et al., Prevalence, persistence, and clinical significance of masked hypertension in youth, Hypertension, 2005, 45, 493–498. http://dx.doi.org/10.1161/01.HYP.0000160320.39303.ab[Crossref]
-  Williams C.L., Hayman L.L., Daniels S.R., Robinson T.N., Steinberger J., Paridon S., et al., Cardiovascular health in childhood. A statement for health professionals from the committee on atherosclerosis, hypertension, and obesity in the young (AHOY) of the council on cardiovascular disease in the young, American Heart Association, Circulation, 2002, 106, 143–160.
-  Burt V.L., Whelton P., Roccella E.J., Brown C., Cutler J.A., Higgins M.,et al., Prevalance of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension, 1995, 25, 305–313.
-  Altun B., Arici M., Nergizoğlu G., Derici U., Karatan O., Turgan C., et al.; for the Turkish Society of Hypertension and Renal Diseases, Prevalance, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003, J. Hypertens., 2005, 23, 1817–1823. http://dx.doi.org/10.1097/01.hjh.0000176789.89505.59[Crossref]
-  Slovut D.P., Olin J.W., Fibromuscular dysplasia, N. Engl. J. Med., 2004, 350, 1862–1871. http://dx.doi.org/10.1056/NEJMra032393[Crossref]
-  Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green L.A., Izzo J.L. Jr, et al., Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Hypertension, 2003, 42, 1206–1252.
-  National Institutes of Health, Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report, Obes. Res., 1998, 6(suppl 2), 51S–209S.
-  Onusko E., Diagnosing secondary hypertension, Am Fam Physician., 2003, 67, 67–74.
-  Kaplan N.M., Hypertension in the population at large, In: Kaplan N.M. (Editor), Kaplan’s Clinical Hypertension, 8th ed., Lippincott Williams & Wilkins, Philadelphia, 2002.
-  Kaplan N.M., Hypertension in childhood and adolescence, In: Kaplan N.M. (Editor), Kaplan’s Clinical Hypertension, 8th ed., Lippincott Williams & Wilkins, Philadelphia, 2002.
-  Cloher T.P., Whelton P.K., Physician approach to the recognition and initial management of hypertension. Results of a statewide survey of Maryland physicians, Arch. Intern. Med., 1986, 146, 529–533. http://dx.doi.org/10.1001/archinte.146.3.529[Crossref]
-  Steven I.D., Wilson D.H., Wakefield M.A., Beilby J., Coffey G.A., Esterman A.J., et al., South Australian hypertension survey. General practitioner knowledge and reported management practices - a cause for concern? Med. J. Aust., 1992, 156, 423–428.
-  Ribacke M., The concept of individualized hypertension care in general practice and outpatient clinics. The general practitioner hypertension practice study (III), Scand. J. Prim. Health Care, 1995, 13(2), 112–117. http://dx.doi.org/10.3109/02813439508996746[Crossref]
-  Wilhelmsen L., Strasser T., WHO-WHL Hypertension Management Audit Project, J. Hum. Hypertens., 1993, 7(3), 257–263.
-  Krieger D.R., Landsberg L., Obesity and hypertension, In: Laragh J.H., Brenner B.M. (Eds.), Hypertension: Pathophysiology, Diagnosis, and Management. 2nd ed., Raven Pres Ltd, New York, 1995.
-  Health implications of obesity: National Institutes of Health Consensus Development Conference Statement, Ann. Intern. Med., 1985, 103, 1073–1077.
-  Dyer A.R., Elliott P., The INTERSALT study: relations of body mass index to blood pressure. INTERSALT Co-operative Research Group, J. Hum. Hypertens., 1989, 3, 299–308.
-  Jousilahti P., Tuomilehto J., Vartiainen E., Vale T., Nissinen A., Body mass index, blood pressure, diabetes and the risk of anti-hypertensive drug treatment: 12-year follow-up of middle-aged people in eastern Finland, J. Hum. Hypertens., 1995, 9, 847–854.
-  Hamet P., Pausova Z., Adarichev V., Adaricheva K., Tremblay J., Hypertension: genes and environment, J. Hypertens., 1998, 16, 397–418. http://dx.doi.org/10.1097/00004872-199816040-00001[Crossref]
-  Ludvik B., Nolan J.J., Baloga J., Sacks D., Olefsky J., Effect of obesity on insulin resistance in normal subjects and patients with NIDDM, Diabetes, 1995, 44(9), 1121–1125. http://dx.doi.org/10.2337/diabetes.44.9.1121[Crossref]
-  Reaven G.M., Insulin resistance/compensatory hyperinsulinemia, essential hypertension, and cardiovascular disease, J. Clin. Endocrinol. Metab., 2003, 88(6), 2399–2403. http://dx.doi.org/10.1210/jc.2003-030087[Crossref]
-  Reaven G., All obese individuals are not created equal:insulin resistance is the major determinantof cardiovascular disease in overweight/obese individuals, Diabetes. Vasc. Dis. Res., 2005, 2, 105–112. http://dx.doi.org/10.3132/dvdr.2005.017[Crossref]
-  Ferrannini E., Buzzigoli G., Bonadonna R., Giorico M.A., Oleggini M., Graziadei L., et al., Insulin resistance in essential hypertension, N. Engl. J. Med., 1987, 317, 350–357.
-  Shamiss A., Carroll J., Rosenthal T., Insulin resistance in secondary hypertension, Am. J. Hypertens., 1992, 5(1), 26–28. [Crossref]
-  Mancia G., De Backer G., Dominiczak A., Cifkova R., Fagard R., Germano G., et al., The task force for the management of arterial hypertension of the European Society of Hypertension, The task force for the management of arterial hypertension of the European Society of Cardiology., 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)., Eur. Heart. J., 2007, Jun; 28(12), 1462–536.
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