Inflation of diagnostic tests in hypertensive young adults: a need for diagnostic guideline?

Abstract

AbstractThe 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.