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Diagnosis and treatment of secondary hypertension


This session covered various interesting fundamental aspects of secondary hypertension by top researchers in the field.
Although secondary hypertension accounts for a small proportion of hypertensive patients, we must maintain a high level of clinical suspicion, since it may lead to treatment resistance, while it represents a potentially curable disease.
Endocrine hypertension is the most common cause of secondary hypertension in adults with primary aldosteronism as the principal condition.
Prof. Rossi gave an excellent talk on primary aldosteronism. He nicely emphasized the need for wider population screening through the use of aldosterone/renin ratio levels. In addition, he presented important information on the role of gene mutations in the pathophysiology of the disease, with particular emphasis in KNCJ5 which is the most prevalent one.
Prof. MacDonald gave a very informative talk on pheochromocytoma, sharing his valuable clinical experience with the audience. He emphasized the different presentations of the disease that a clinician may easily miss. Periodic follow up is mandatory, while genetic testing may help in personalized therapy and follow-up, as well as in early detection in relatives.
Prof. Limbourg delivered an excellent presentation on the most controversial topic of the session, the treatment of atheromatic renovascular disease. Although the safety and efficacy of renal angioplasty and stenting have improved in recent years, the treatment strategy still does not show significant benefits of revascularizaton. The therapeutic approach lacks consensus due to the lack of large well-designed randomized trials. Intrarenal damage determines the treatment response in interventional treatment. Better strategies are needed and these might include cell therapies in the future.
The topic of aortic coarctation was very effectively covered by Prof. Deanfield. The issue is difficult, since this group of patients suffers from significant cardiovascular morbidity and mortality. Hypertension remains an unresolved issue even in patients who successfully underwent intervention.




Diagnosis and treatment of secondary hypertension

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.