Hypertension in Young Adults

Introduction to Hypertension

In young adults, 85-95% of hypertension diagnoses are considered primary before the age of 30, according to the American College of Physicians 1, 2
The likelihood of secondary causes of hypertension increases with younger age: children under 6 years old have a higher proportion of secondary hypertension than older children and adolescents, as stated by the American Academy of Pediatrics 1, 5

Renal parenchymal disease should be considered, with a history of urinary tract infections, obstruction, hematuria, nocturia, or family history of polycystic kidney disease, as recommended by the American College of Physicians 3, 6
Renovascular disease, particularly fibromuscular dysplasia (typically seen in women under 40), should be evaluated, according to the American Heart Association 6, 4
Primary aldosteronism, which accounts for 8-20% of resistant hypertension, presenting with spontaneous or diuretic-induced hypokalemia, should be considered, as stated by the Endocrine Society 3, 6
Aortic coarctation should be considered in young patients with hypertension, measuring leg blood pressure, as recommended by the American College of Cardiology 3, 4

A detailed medical history, including duration of hypertension, previous blood pressure levels, symptoms suggesting secondary causes, and medication use (including NSAIDs, oral contraceptives, and decongestants), is essential, as stated by the American Academy of Family Physicians 3, 6
Physical examination, including femoral pulse, abdominal bruit, Cushing's syndrome features, and neurofibromatosis skin manifestations, should be performed, according to the American College of Physicians 6
Basic laboratory tests, including serum potassium, serum creatinine and eGFR, urinalysis, and thyroid function, should be conducted, as recommended by the National Kidney Foundation 3, 6
Targeted screening, such as plasma aldosterone-to-renin ratio (for primary aldosteronism), should be considered, as stated by the Endocrine Society 3, 6
Echocardiography (to evaluate aortic coarctation and left ventricular hypertrophy) should be performed, according to the American College of Cardiology 6

Treating the underlying cause of secondary hypertension may lead to cure or significant improvement, as stated by the American College of Physicians 3, 6