Continuing Medical Education

An approach to the young hypertensive patient

Phetho Mangena, Sadick Saban, Kefilwe Hlabyago, Brian Rayner

Abstract


Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and
young adults <40 years of age. In South Africa, the first decade of the millennium saw a doubling of the prevalence rate among adolescents and young
adults aged 15 - 24 years. This increase suggests that an explosion of cerebrovascular disease, cardiovascular disease and chronic kidney disease can be
expected in the forthcoming decades. A large part of the increased prevalence can be attributed to lifestyle factors such as diet and physical inactivity,
which lead to overweight and obesity. The majority (>90%) of young patients will have essential or primary hypertension, while only a minority
(<10%) will have secondary hypertension. We do not recommend an extensive workup for all newly diagnosed young hypertensives, as has been the
practice in the past. We propose a rational approach that comprises a history to identify risk factors, an examination that establishes the presence of
target-organ damage and identifies clues suggesting secondary hypertension, and a limited set of basic investigations. More specialised tests should
be performed only where there is a clinical suspicion that a secondary cause for hypertension exists. There have been no randomised clinical trials on
the treatment of hypertension in young patients. Expert opinion advises an initial emphasis on lifestyle modification. This can comprise a diet with
reduced salt and refined carbohydrate intake, an exercise programme and management of substance abuse issues. Failure of lifestyle measures or the
presence of target-organ damage should prompt the clinician to initiate pharmacotherapy. We recommend referral to a specialist practitioner in cases
of resistant hypertension, where there is severe target-organ damage and when a secondary cause is suspected.


Authors' affiliations

Phetho Mangena, Division of Nephrology and Hypertension, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

Sadick Saban, Private Practice, and Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Kefilwe Hlabyago, Department of Family Medicine, Dr George Mukhari Academic Hospital and Sefako Makgatho Health Sciences University, Pretoria, South Africa

Brian Rayner, Division of Nephrology and Hypertension, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

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Keywords

Young patient; Hypertension

Cite this article

South African Medical Journal 2016;106(1):36-38. DOI:10.7196/SAMJ.2016.v106i1.10329

Article History

Date submitted: 2015-11-10
Date published: 2015-11-26

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