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Cited by 562Hormonal Regulation and HypertensionBlood Pressure and Hypertension StudiesRenal and Vascular Pathologies

Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan.

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OMURA, Masao, SAITO, Jun, YAMAGUCHI, Kunio, KAKUTA, Yukio, NISHIKAWA, Tetsuo·2004·Hypertension Research
DOI 10.1291/hypres.27.193
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Abstract

Secondary hypertension (SH) including endocrine hypertension has been reported to be uncommon. We estimated the prevalence of SH among hypertensive patients. We prospectively studied 1,020 hypertensive patients. As an initial screening, we measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration and plasma catecholamine concentration and conducted abdominal ultrasonography (US). As a secondary screening, we performed furosemide plus upright test, captopril renography, dexamethasone suppression test, 24-h urine catecholamine measurement and abdominal CT. Finally, primary aldosteronism with the exception of idiopathic hyperaldosteronism, pheochromocytoma, and Cushing's syndrome were diagnosed by histopathological examination of surgical specimens. Idiopathic hyperaldosteronism was clinically diagnosed by adrenocorticotrophic hormone (ACTH)-stimulated adrenal venous sampling and renovascular hypertension by renal arteriography. There were 61 patients with primary aldosteronism, 5 with renovascular hypertension, 11 with Cushing's syndrome, 10 with preclinical Cushing's syndrome and 6 with pheochromocytoma, and the prevalence of SH was 9.1% among 1,020 hypertensive patients. In 76 (82%) of 93 patients with SH, hypertension was cured or improved after unilateral adrenalectomy, transsphenoidal pituitary adenectomy or percutaneous transluminal angioplasty. With the exception of US and CT, all initial and secondary screening tests were found to be sensitive and specific for differentiating SH from essential hypertension (EH). In conclusion, the measurement of various hormone concentrations was very sensitive for ruling out SH--a condition for which, in the present study, there were few specific signs or symptoms--while CT and US examinations were not always useful for differentiating SH from EH. The prevalence of curable SH among hypertensive subjects was higher in this study, which was conducted by our simple method of screening tests, than in previous reports. Hypertensive patients should be screened for SH and the underlying disease treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complications.

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  • Screening studies of patients with hypertension reported a 0.5-1% prevalence of Cushing's syndrome.

    “Screening studies of patients with hypertension reported a 0.5-1% prevalence of Cushing's syndrome (36,37).”

    From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [37]

  • Ten percent of pheochromocytomas can be malignant and 40% are familial.

    “Ten percent can be malignant and 40% are familial (Von-Hippel-Lindau disease, Multiple Endocrine Neoplasia type 2A and 2B, Neurofibromatosis type 1, Carney Triad, Succinate Dehydrogenase gene Mutations, plus a few other rare genetic forms).128”

    From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [128]

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Research works printed but not linked: 3

  1. Hiramatsu K, Yamada T, Yukimura Y, et al: A screening test to identify aldosterone-producing adenoma by mea- surement plasma renin activity. Arch Intern Med 1981; 141: 1589-1593.
  2. Fardella CE, Mosso L, Gómez-Sánchez C, et al: Primary aldosteronism in essential hypertensives: prevalence, bio- chemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863-1867.
  3. Martinez-Amenos A, Rama H, Sarrias X, et al: Percuta- neous transluminal angioplasty in the treatment of renovas- cular hypertension. J Hum Hypertens 1991; 5: 97-100.

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Authors
OMURA, M., SAITO, J., YAMAGUCHI, K., KAKUTA, Y., & NISHIKAWA, T.
Affiliations
Yokohama Rosai Hospital (JP)
ORCID
Venue
Hypertension Research
Publisher
Japanese Society of Hypertension
Published
2004
Volume
27
Issue
3
Pages
193-202
ISSN
  • 0916-9636 (ISSN-L)
  • 1348-4214
DOI
10.1291/hypres.27.193
OpenAlex
W1990806018
Cited by
562
References
42
Citations by year
2026: 6 · 2025: 19 · 2024: 22 · 2023: 25 · 2022: 28 · 2021: 31 · 2020: 38 · 2019: 31 · 2018: 31 · 2017: 31 · 2016: 32 · 2015: 34 · 2014: 29 · 2013: 28 · 2012: 31
FWCI
10.95
Type
journal article
Language
en
Open access
Locations
  • Hypertension Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
secondary hypertension, prevalence, primary aldosteronism, idiopathic hyperaldosteronism, pheochromocytoma, Cushing's syndrome, renovascular hypertension, endocrine hypertension, screening test, adrenalectomy, percutaneous transluminal angioplasty, essential hypertension, plasma aldosterone, plasma renin activity, plasma cortisol
MeSH terms
Adrenal Gland Diseases, Adrenal Gland Neoplasms, Adrenalectomy, Ambulatory Care Facilities, Angioplasty, Balloon, Cushing Syndrome, Humans, Hyperaldosteronism, Hypertension, Hypertension, Renovascular, Mass Screening, Pheochromocytoma, Pituitary Gland, Prospective Studies, Sensitivity and Specificity, Prevalence, Treatment Outcome

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