Investigation and management of young-onset hypertension: British and Irish hypertension society position statement

Spoorthy Kulkarni^{1

2}, Luca Faconti³, Sarah Partridge⁴, Christian Delles⁵, Mark Glover⁶, Philip Lewis⁷, Asha Gray¹, Emma Hodson¹, Iain Macintyre⁸, Carmen Maniero⁹, Carmel M McEniery², Manish D Sinha¹⁰, Stephen B Walsh¹¹, Ian B Wilkinson²

Affiliations

¹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
² Division of Experimental Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
³ King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, 4th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge, London, SE1 7EH, UK.
⁴ Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK. s.partridge@bsms.ac.uk.
⁵ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK.
⁶ Deceased, formerly Division of Therapeutics and Molecular Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2QL, UK.
⁷ Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK.
⁸ Department of Renal Medicine, Royal Infirmary of Edinburgh, National Health Service Lothian, Lothian, EH16 4SA, UK.
⁹ William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
¹⁰ Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London, SE1 7EH, UK.
¹¹ London Tubular Centre, Department of Renal Medicine, Royal Free NHS Trust, University College London, London, NW3 2QG, UK.

PMID: 38942895
PMCID: PMC11239491
DOI: 10.1038/s41371-024-00922-5

Review

Investigation and management of young-onset hypertension: British and Irish hypertension society position statement

Spoorthy Kulkarni et al. J Hum Hypertens. 2024 Jul.

. 2024 Jul;38(7):544-554.

doi: 10.1038/s41371-024-00922-5. Epub 2024 Jun 28.

Authors

Affiliations

¹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
² Division of Experimental Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
³ King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, 4th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge, London, SE1 7EH, UK.
⁴ Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK. s.partridge@bsms.ac.uk.
⁵ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK.
⁶ Deceased, formerly Division of Therapeutics and Molecular Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2QL, UK.
⁷ Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK.
⁸ Department of Renal Medicine, Royal Infirmary of Edinburgh, National Health Service Lothian, Lothian, EH16 4SA, UK.
⁹ William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
¹⁰ Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London, SE1 7EH, UK.
¹¹ London Tubular Centre, Department of Renal Medicine, Royal Free NHS Trust, University College London, London, NW3 2QG, UK.

PMID: 38942895
PMCID: PMC11239491
DOI: 10.1038/s41371-024-00922-5

Abstract

National and international hypertension guidelines recommend that adults with young-onset hypertension (aged <40 years at diagnosis) are reviewed by a hypertension specialist to exclude secondary causes of hypertension and optimise therapeutic regimens. A recent survey among UK secondary care hypertension specialist physicians highlighted variations in the investigation of such patients. In this position statement, the British and Irish Hypertension Society seek to provide clinicians with a practical approach to the investigation and management of adults with young-onset hypertension. We aim to ensure that individuals receive consistent and high-quality care across the UK and Ireland, to highlight gaps in the current evidence, and to identify important future research questions.

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Conflict of interest statement

Professor Adrian J.B. Brady has received honoraria from Daiichi-Sankyo, Amgen, Sanofi-Aventis, Bayer, MSD, and Novartis. Professor Phil Chowienczyk has an interest in Centron Diagnostics, a company that has produced technology for blood pressure measurement. Dr Jacob George has received grants and travel funding from Daiichi Sankyo, is on Advisory Boards for AstraZeneca and Novartis, and is a Principal Investigator for studies funded by AstraZeneca, Alnylam, Novartis, Esperion. Dr Pankaj Gupta has received research grants, lecture honoraria funding for conference attendance from Sanofi-Aventis and Amgen, and consulting fees from Ionis Pharmaceuticals. Dr Spoorthy Kulkarni is a PhD student at the University of Cambridge funded by AstraZeneca and has attended scientific advisory boards for Viatris. Dr Iain MacIntyre has received honoraria from AstraZeneca and is a Principal Investigator for studied funded by Alnylam Pharmaceuticals. Professor Terry McCormack has received lecture honoraria and/or consultation fees from Amarin, AstraZeneca, Bayer, Daichi-Sankyo, Medtronic, Novartis, OMRON and Sanofi-Aventis. Professor Neil R Poulter has received lecture honoraria and/or consultation fees from several pharmaceutical companies that manufacture blood pressure lowering agents including AstraZeneca, Eva Pharma, Lri Therapharma, Napi, Pfizer, Servier, and Sanofi-Aventis. Dr. Pauline Swift has received lecture honoraria from AstraZeneca, Boehringer-Ingelheim and Bayer. Professor Ian B Wilkinson has received research grants from AstraZeneca, GSK, and scientific advisory board consultation fees for Viatris, Astra Zeneca and Roche. Professor Christian Delles, Dr. Luca Faconti, Dr. Asha Gray, Dr. Emma Hodson, Dr. Andrew Jordan, Dr. Vikas Kapil, Dr. Philip Lewis, Dr. Carmen Maniero, Dr Carmel M McEniery, Professor Peter Sever, Dr. Manish B Sinha, Dr. James Sheppard, Dr. Wayne Sunman, Mr. Sam Olden, Dr. Sarah Partridge and Professor Stephen B Walsh have no competing interest to declare for this manuscript.

Figures

**Fig. 1. Retinal fundus showing hypertension-mediated end organ damage.**
1 = Blurred disc margins and papilloedema, 2 = Cotton wool spots, 3 = Generalized arteriolar attenuation and tortuosity.

**Fig. 2. Ambulatory blood pressure monitoring demonstrating white coat hypertension.**
Ambulatory Blood Pressure Monitoring (ABPM) from a patient with young-onset hypertension demonstrating white coat effect with office/clinic BP and the first reading on ABPM > 140/90 mmHg but normal day, night (grey shaded area) and total BP averages.

**Fig. 3. Ambulatory blood pressure monitoring demonstrating masked hypertension.**
Ambulatory Blood Pressure Monitoring (ABPM) from a patient with young-onset hypertension demonstrating masked hypertension with office/clinic BP and the first reading on ABPM < 140/90 mmHg but elevated daytime average BP. The grey shaded area denotes night-time readings.

**Fig. 4. Investigation and treatment of young-onset hypertension.**
ABPM Ambulatory blood pressure monitoring, BB Beta blocker BP Blood pressure, CVD Cardiovascular disease, CCB Calcium channel blocker, DM Diabetes mellitus, HBPM Home blood pressure monitoring, HT Hypertension, RAAS Renin-angiotensin-aldosterone system, Rx Treatment. [1] Kulkarni S et al., J Hum Hypertens. 2023;37(10):863–79 [2] NICE guideline NG136: https://www.nice.org.uk/guidance/ng1362022 [3] Lewis P. et al., J Hum Hypertens. 2024;38(1):3–7.

See this image and copyright information in PMC

References

1. Lewis P, George J, Kapil V, Poulter NR, Partridge S, Goodman J, et al. Adult hypertension referral pathway and therapeutic management: British and Irish Hypertension Society position statement. J Hum Hypertens. 2024;38:3–7. doi: 10.1038/s41371-023-00882-2. - DOI - PMC - PubMed
1. Mancia G, Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) J Hypertens. 2023;41:1874–2071. doi: 10.1097/HJH.0000000000003480. - DOI - PubMed
1. National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE guideline [NG136]. Published 28 August 2019, Last updated: 21 November 2023. https://www.nice.org.uk/guidance/ng1362022.
1. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75:1334–57. doi: 10.1161/HYPERTENSIONAHA.120.15026. - DOI - PubMed
1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2018;36:2284–309. doi: 10.1097/HJH.0000000000001961. - DOI - PubMed

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Investigation and management of young-onset hypertension: British and Irish hypertension society position statement

Affiliations

Investigation and management of young-onset hypertension: British and Irish hypertension society position statement

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Full Text Sources

Medical