Secondary arterial hypertension in the practice of a family doctor: analysis of a clinical case

Background. Over the past decades, tremendous progress has been made in understanding, diagnosing, and treating secondary forms of arterial hypertension (AH). The prevalence of secondary AH is significantly underestimated. According to leading experts in the field, it may account for up to one-third of all patients with AH and up to half of those with resistant AH. In the vast majority of hypertensive patients, the cause of their high blood pressure (BP) is never sought, that is, the «secondary» form of AH. This explains why only a small percentage of hypertensive patients are ultimately diagnosed with the secondary form of AH. Purpose – to demonstrate the algorithm for searching for a secondary cause of AH in a young patient using a clinical case example. Materials and methods. The case history of a 33-year-old woman is presented. She consulted a physician due to periodic hypertension, resistant to standard antihypertensive therapy for 6 months. A secondary form of AH was suspected due to hormonally active adrenal adenoma. Results and discussion.The article illustrates the algorithm for searching for a secondary cause of AH in a young patient. The family doctorʼ s actions are described step by step, which allowed narrowing the diagnostic search to the verification of an adrenal tumor and determining its hormonal activity. Establishing the diagnosis of pheochromocytoma as the cause of secondary form of AH allowed to prescribe the patient pathogenetic therapy and thus prevent possible complications of the disease. Conclusions. Young patients with elevated BP require mandatory examination for the presence of secondary form of AH. Taking into consideration its numerous possible causes and the need to «narrow» the search scope, US is an informative method for the doctor and absolutely safe for the patient. Despite the fact that this examination is not an independent one in the diagnosis of adrenal adenomas and requires supplementation with other imaging methods, it is able to prompt the doctor for further tactics. Identification of the etiology of secondary form of AH in a large proportion of patients allows to prescribe the pathogenetic therapy and eliminate elevated BP, and in the case of the impossibility of the problem radical solution to administrate antihypertensive therapy adequate to the found cause.