Epidemiology and Left Ventricular Impact of Secondary Hypertension: A Case Series

Abstract

Secondary hypertension is defined as arterial hypertension due to an identifiable cause, and therefore can be cured when the underlying cause is treated. It is a rare entity, often underdiagnosed, with an overall prevalence estimated at 10% of hypertensive patients in literature. However, it is important to look for it given its reversible nature after treatment of the cause. This is a case series aiming to uncover this often heterogeneous entity by highlighting its epidemiological particularities and its impact on the left ventricle in our patient population and comparing its results with data in literature. The left ventricle is a primary target for hypertension end-organ damage. In addition to being a marker of hypertension, left ventricular hypertrophy (LVH) is a major independent risk factor for not only cardiovascular disease morbidity and mortality but also for all-cause mortality and neurological pathologies. Electrocardiogram and 2D transthoracic echocardiography are the primary diagnostic tools for the diagnosis and quantification of LVH. To identify the cause of hypertension in our patients, radiological examinations were used such as renal artery ultrasound, abdominal CT scan, and arteriography. Polysomnography was also used when obstructive sleep apnea was suspected. Routine blood tests were performed such as potassium level, as well as aldosterone level and plasma renin activity in case of suspected primary aldosteronism. In our case series, primary aldosteronism was the most frequent etiology of secondary hypertension representing 22.7% of the cases as well as renal artery stenosis. Primary aldosteronism, also known as Conn’s syndrome, is described in literature as the most common form of secondary hypertension.