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'Essential' arterial hypertension: time for a paradigm change
Gian Paolo Rossi1,2, Domenico Bagordo2,3, Federico B Rossi2,3
1Internal & Emergency Medicine.
Insights
Essential hypertension is often overdiagnosed, masking curable secondary hypertension. Systematic investigation reveals secondary hypertension is common and treatable, improving patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Practice
Background:
- Essential hypertension is frequently diagnosed without systematically excluding secondary causes.
- This diagnostic approach leads to a high prevalence of essential hypertension, potentially overlooking curable conditions.
Purpose of the Study:
- To review the historical development of essential hypertension as a diagnosis.
- To evaluate current scientific evidence regarding the prevalence of secondary hypertension.
Main Methods:
- Literature review of recent studies on hypertension etiology.
- Analysis of evidence supporting the prevalence of secondary hypertension.
Main Results:
- Recent studies provide strong evidence that secondary hypertension is common when systematically investigated.
- Secondary hypertension is highly prevalent, challenging the notion of essential hypertension's dominance.
Conclusions:
- Increased clinical awareness is needed to systematically search for secondary causes of hypertension.
- Early detection and treatment of secondary hypertension can improve blood pressure control and patient quality of life.
Abstract:
The exclusion of causes of hypertension is not systematically exploited in clinical practice. Therefore, essential hypertension is consistently presented as the most prevalent 'cause'. The paradox of a condition with unknown causes being described as a common cause of hypertension translates into a diagnosis of essential hypertension in most patients, which precludes the detection of a curable cause of hypertension. The aim of this review is to investigate how the notion of essential hypertension has developed and whether scientific evidence still support the notion of its high prevalence by examining the most recent studies. These studies provided solid scientific evidence that, when systematically sought for, secondary hypertension is quite common and that secondary hypertension is highly prevalent. The increased awareness should lead to a systematic search for, with the goal of curing or achieving a better control of high blood pressure, and ultimately improving patients' quality of life.
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