Secondary Hypertension - A Kaleidoscopic View From a Tertiary Centre in South India

Abstract

According to data published by WHO, an estimated 1.4 billion adults aged 30-79 years worldwide had hypertension in 2024; this represents 33% of the population in this age range. Two-thirds of adults aged 30-79 years who have hypertension live in low- and middle-income countries. An estimated 600 million adults with hypertension (44%) are unaware that they have the condition. Approximately 630 million adults with hypertension (44%) are diagnosed and treated. Only approximately 320 million adults with hypertension (23%) have it under control. It is estimated that at least one in four adults in India has hypertension [1] but, only about 12% of them have their blood pressure under control [2]. Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence of secondary hypertension is close to 30% in those hypertensives 18 to 40 years of age, and it varies by age [3]. In the cross-sectional survey study of Indian adults by Varghese JS et al, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control [4]. We present a series of 9 patients that illustrates how 'hypokalemia – hypertension duo', at presentation in the emergency department offers an important cue to proceed with work up for hyperaldosteronism, no matter with what system involvement the patient presents (eg: be it a cerebrovascular accident, periodic palsy or seizure.)