Etiological Diagnosis and Personalized Therapy for Hypertension: A Hypothesis of the REASOH Classification

Abstract

With the epidemic of risk factors such as unhealthy lifestyle, obesity and mental stress, the prevalence of hypertension continues to rise across the world. Although standardized treatment protocols simplify the selection of antihypertensive drugs and ensure therapeutic efficacy, the pathophysiological state of some patients remains, which may also lead to the development of other cardiovascular diseases. Thus, there is an urgent need to consider the pathogenesis and selection of antihypertensive drug for different type of hypertensive patients in the era of precision medicine. We proposed the REASOH classification, based on the etiology of hypertension, including renin-dependent hypertension, elderly-arteriosclerosis-based hypertension, sympathetic-active hypertension, secondary hypertension, salt-sensitive hypertension and hyperhomocysteinemia hypertension. The aim of this paper is to propose a hypothesis and provide a brief reference for the personalized treatment of hypertensive patients.

Keywords: REASOH classification; etiological diagnosis; hypertension; personalized therapy.

Figure 1

The REASOH classification: a hypothesis about etiological diagnosis and personalized therapy for hypertension. ACEIs: angiotensin-converting enzyme inhibitors; ARBs: angiotensin-receptor blockers; ARNI: angiotensin receptor blocker and neprilysin inhibitor; ba-PWV: brachial-ankle pulse wave velocity; CCB: calcium channel blocker; cf-PWV: carotid-femoral pulse wave velocity; PRA: plasma renin activity.

Figure 2

Recommended screening process for patients with suspected secondary hypertension. CT: computed tomography; MRA: magnetic resonance angiography.