'Essential' arterial hypertension: time for a paradigm change

Abstract

The exclusion of causes of hypertension is not systematically exploited in clinical practice. Therefore, essential hypertension is consistently presented as the most prevalent 'cause'. The paradox of a condition with unknown causes being described as a common cause of hypertension translates into a diagnosis of essential hypertension in most patients, which precludes the detection of a curable cause of hypertension. The aim of this review is to investigate how the notion of essential hypertension has developed and whether scientific evidence still support the notion of its high prevalence by examining the most recent studies. These studies provided solid scientific evidence that, when systematically sought for, secondary hypertension is quite common and that secondary hypertension is highly prevalent. The increased awareness should lead to a systematic search for, with the goal of curing or achieving a better control of high blood pressure, and ultimately improving patients' quality of life.

FIGURE 1

The cartoon illustrates the vicious circle whereby the misbelief that secondary hypertension is exceptional translates into a very low rate of screening for secondary forms, thereby leading to identification of secondary hypertension only a small subset, thus reinforcing the misbelief that 95–99% of the patients have ‘essential’ hypertension.

FIGURE 2

When facing a patient with essential hypertension without ascertaining the underlying pathophysiology, doctors are like the six blind-folded researchers examining the elephant in the cartoon: their understanding of real facts based on limited data is incomplete and, hence, inaccurate. Picture from: Himmelfarb et al. 2002 [48]: 1526 (artist: G. Renee Guzlas). All rights reserved ©.