Screening of Secondary Hypertension in Private Clinic in Karachi, Pakistan: A Randomised Study

Hypertension hasbeen recognized as aglobalhealth concern fordeveloping countries.Secondary hypertension(SH)including endocrine hypertension has been reported to be uncommon and is scarcely described in many of these countries. There is no current nationally representative study. Therefore, we estimated the prevalence of SH among hypertensive patients in private clinic by screening. The goal of the cross-sectional study conducted from May 2017to June2018 was to estimate the prevalence of hypertension inPakistani population based on data collected fromthe screening held at private clinic inKarachi. From the initial screening of 566 patients, we suspected 437 (M:187), (F:250) patients to have secondary hypertension and conducted tests for the cause of hypertension, measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration an dpasmacatechol amine concentration. Asasecondary screening, were ferred patients for furosemide plus upright test, captopril renography, dexamethasone suppression test, abdominal ultrasonography (US), abdominal CT. and arteriography investigations. These tests clearly demonstrated that the prevalence of Secondary Hypertension was 8.1% among 437 patients investigated. 42 were found to have Renal parenchymal disease; 25 were having Acute Renal Failure; 15 patients had Calculi; 29 patients had chronic glomerulonephritis leading to CRF and 3 had reno vascular hypertension. Further, 2 cases with aortic coarctation were found on arteriography; 1 patient had primary aldosteronism; 5 had primary hyperparathyroidism; 6 patients had hyperthyroidism and 11 had Hypothyroidism. In seven cases of hydronephrosis (two known and five newly detected) we could not determine whether the hypertension was caused by the hydronephrosis. The prevalence of curable SH among hypertensive subjects was higher in this screening study, conducted in majority of cases with simple tests. The rates of blood pressure screening in Pakistan are worryingly low; the underlying disease in hypertensive patients should be treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complication. This calls for the establishment of a nationwide program on screening to improve detection, awareness and treatment of hypertension.