Abstract #124 Adrenal Medullary Hyperplasia as a Cause of Secondary Hypertension and Metanephrines Excess.

Moringa oleifera (M. oleifera) is an angiosperm plant that is a member of the Moringaceae family. It is a natural plant that is native to the sub-Himalayan northern regions of India, Bangladesh, Pakistan, and Afghanistan. The plant grows abundantly throughout tropical and subtropical areas of the world. For several centuries, many cultures have utilized various parts of the moringa plant as traditional medicine to treat common illnesses and control life-threatening conditions such as hypertension (HTN), diabetes, hyperlipidemia, inflammation, etc. This article reviewed the current literature on the therapeutic benefits of M. oleifera on hypertension, primarily focusing on identifying the plant’s key components and its roles in hindering the common pathophysiological pathways associated with hypertension. The number of people living with HTN has been predicted to increase to 1.56 billion worldwide by 2025 in spite of the myriads of preventive and treatment strategies available today. Therefore, it would be of great value to explore alternative complementary ways of controlling high blood pressure. HTN is commonly defined as blood pressure equal to or higher than 140/90 mm Hg. HTN itself is not a disease condition and does not elicit specific symptoms, however, if left untreated for a long time, it can lead to complicated cardiovascular diseases such as angina, congestive heart failure, myocardial infarction as well as stroke and chronic kidney diseases. Primary hypertension is diagnosed when there is no known identifiable underlying cause for the onset of the condition. Secondary hypertension is diagnosed when there is evidence of a disease or disorder triggering the onset of the condition. It is apparent that understanding the role of M. oleifera in the management of hypertension would expand the valuable strategies for the control of this condition.

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A Rare Cause of Secondary Hypertension in A Young Adult

Korean Circulation Journal ◽

10.4070/kcj.2015.45.6.531 ◽

2015 ◽

Vol 45 (6) ◽

pp. 531

Author(s):

Jae-Hyuk Choi ◽

Tae-Ho Park ◽

Moo-Hyun Kim ◽

Young-Dae Kim ◽

Hyo In Rhyou ◽

...

Keyword(s):

Young Adult ◽

Secondary Hypertension

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The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽

10.3390/pharmaceutics13050714 ◽

2021 ◽

Vol 13 (5) ◽

pp. 714

Author(s):

Elisabeta Bădilă ◽

Cristina Japie ◽

Emma Weiss ◽

Ana-Maria Balahura ◽

Daniela Bartoș ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renin Angiotensin System ◽

Drug Regimen ◽

Secondary Hypertension ◽

Adverse Outcomes ◽

Uncontrolled Hypertension ◽

White Coat Hypertension ◽

Mineralocorticoid Receptor Antagonist ◽

Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

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Characteristics of pediatric inpatients with primary and secondary hypertension

Pediatric Investigation ◽

10.1002/ped4.12249 ◽

2021 ◽

Vol 5 (1) ◽

pp. 28-32

Author(s):

Yijun Chen ◽

Peiyu Ye ◽

Xiaorong Liu ◽

Chunxiu Gong ◽

Caifeng Li ◽

...

Keyword(s):

Secondary Hypertension

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False elevations in urinary metanephrines: under-recognised pitfall with 24-hour urinary volume collection

BMJ Case Reports ◽

10.1136/bcr-2020-241147 ◽

2021 ◽

Vol 14 (2) ◽

pp. e241147

Author(s):

Terry Shin ◽

Thanh Duc Hoang ◽

Mary Thomas Plunkett ◽

Mohamed K M Shakir

Keyword(s):

African American Woman ◽

Urine Volume ◽

American Woman ◽

Secondary Hypertension ◽

Reference Laboratory ◽

Urine Collection ◽

Urinary Volume ◽

Normal Limits ◽

Incorrect Diagnosis ◽

Urinary Metanephrines

One pitfall in 24-hour urine collection is the input of incorrect urinary volume by the reference laboratory. This may lead to an incorrect diagnosis of pheochromocytoma or paraganglioma. A 48-year-old African-American woman was seen in the clinic for an elevated 24-hour urine metanephrine screen during workup for secondary hypertension. Urine volume was found to be incorrectly inputted by the lab as 9750 mL rather than 975 mL. The urinary metanephrines were then recalculated and the 24-hour urinary metanephrines resulted within normal limits. This case highlights this unique and potentially under-recognised error in testing with 24-hour urine volume collection.

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Blood Pressure Variability in Children With Primary vs Secondary Hypertension

Journal of Clinical Hypertension ◽

10.1111/jch.12322 ◽

2014 ◽

Vol 16 (6) ◽

pp. 437-441 ◽

Cited By ~ 5

Author(s):

Daniel Leisman ◽

Melissa Meyers ◽

Jeremy Schnall ◽

Nataliya Chorny ◽

Rachel Frank ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Secondary Hypertension

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EJE Prize 2013: Regulation of aldosterone secretion: from physiology to disease

Acta Endocrinologica ◽

10.1530/eje-13-0263 ◽

2013 ◽

Vol 168 (6) ◽

pp. R85-R93 ◽

Cited By ~ 30

Author(s):

Felix Beuschlein

Keyword(s):

High Throughput Sequencing ◽

Secondary Hypertension ◽

Small Sample ◽

Cellular Systems ◽

Common Disease ◽

Aldosterone Secretion ◽

Technical Developments ◽

Starting Point

Arterial hypertension is a major cardiovascular risk factor that affects between 10 and 40% of the population in industrialized countries. Primary aldosteronism (PA) is the most common form of secondary hypertension with an estimated prevalence of around 10% in referral centers and 4% in a primary care setting. Despite its high prevalence until recently, the underlying genetic and molecular basis of this common disease had remained largely obscure. Over the past decade, a number of insights have been achieved that have relied onin vitrocellular systems, wild-type and genetically modifiedin vivomodels, as well as clinical studies in well-characterized patient populations. This progress has been made possible by a number of independent technical developments including that of specific hormone assays that allow measurement in small sample volumes as well as genetic techniques that enable high-throughput sequencing of a large number of samples. Furthermore, animal models have provided important insights into the physiology of aldosterone regulation that have served as a starting point for investigation of mechanisms involved in autonomous aldosterone secretion. Finally, national and international networks that have built up registries and biobanks have been instrumental in fostering translational research endeavors in PA. Therefore, it is to be expected that in the near future, further pathophysiological mechanisms that result in autonomous aldosterone secretion will be unraveled.

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Causes of Resistant Hypertension Detected by a Standardized Algorithm

International Journal of Hypertension ◽

10.1155/2012/392657 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Livia Beatriz Santos Limonta ◽

Letícia dos Santos Valandro ◽

Flávio Gobis Shiraishi ◽

Pasqual Barretti ◽

Roberto Jorge da Silva Franco ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Secondary Hypertension ◽

Control Blood Pressure ◽

Primary Level ◽

Standardized Protocol ◽

Frequent Use ◽

Drug Classes ◽

Treatment Of Hypertension ◽

Secondary Causes

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

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