title: Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence.
abstract: BACKGROUND
  Hypertensive urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available.
  
  
  METHODS
  Patients presenting to the emergency room for over 1 year with systolic blood pressure > or =180 mmHg and/or diastolic blood pressure > or =100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after > or =2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed.
  
  
  RESULTS
  Of 161 patients (age, 66.0 +/- 13.1 years; BMI, 28.6 +/- 5.1 kg), 131 had previously identified hypertension (duration, 12.7 +/- 11.5 years; 1.9 +/- 1.5 antihypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5-15/h), 26.8% moderate (15.1-30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), > or =2 in 25 (15.5%), and > or =1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously.
  
  
  CONCLUSIONS
  Secondary causes of hypertension are common and predominantly unrecognized in patients with hypertensive urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.
authors.affiliation: Department of Cardiology and Angiology, University Clinic St. Josef Hospital, Heart Center, University of Bochum, Germany. jan.boergel@rub.de
authors.forename: Jan
authors.initials: J
authors.lastname: Börgel
authors.forename: Stephanie
authors.initials: S
authors.lastname: Springer
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ghafoor
authors.forename: Daniel
authors.initials: D
authors.lastname: Arndt
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Duchna
authors.forename: Andreas
authors.initials: A
authors.lastname: Barthel
authors.forename: Sibylle
authors.initials: S
authors.lastname: Werner
authors.forename: Josef
authors.initials: J
authors.lastname: Van Helden
authors.forename: Christoph
authors.initials: C
authors.lastname: Hanefeld
authors.forename: Horst
authors.initials: H
authors.lastname: Neubauer
authors.forename: Daniel
authors.initials: D
authors.lastname: Bulut
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000453:epidemiology*; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*