Title: Testing for Secondary Hypertension in a Family Medicine Residency Clinic

Author(s): Sarah Lynch, MD

Email: Slynch@mercy.com

Introduction: Hypertension, which affects over 30% of U.S. adults, is a major cardiovascular risk factor. While most cases are essential hypertension, up to 10% are due to a secondary cause. Secondary hypertension should be considered in patients 30 years or younger and in those with resistant hypertension, sudden deterioration in control, severe BP elevations or clinical signs of a cause for secondary hypertension. Identifying secondary hypertension is crucial as it can improve blood pressure control and patient outcomes.

Methods: This retrospective analysis reviewed electronic health records of hypertensive patients seen at the SEBH Family Medicine clinic from June 2022 to October 2023. Comparative analyses assessed associations between clinical variables and the likelihood of undergoing a workup for secondary hypertension.

Results: The study group consisted of 284 patients with hypertension, out of which none were diagnosed with secondary hypertension. Out of these, 90 patients underwent a secondary hypertension workup, with 27.1% having a sleep study and 4.5% undergoing a renal ultrasound or renin/aldosterone labs. Among the 97 patients eligible for a secondary hypertension workup, 26.0% had hypokalemia, 3.8% had resistant hypertension, and 4.2% were diagnosed before age 30. However, only 4.5% received a comprehensive workup, including renin and aldosterone levels or renal ultrasound.

Discussion: The results of this study highlight a deficiency in conducting a thorough evaluation for secondary hypertension in a primary care setting, particularly among patients presenting with hypokalemia, resistant hypertension, and hypertension diagnosed before the age of 30. Only 4.5% underwent a comprehensive workup despite meeting criteria. Enhancing adherence to guidelines for identifying secondary causes of hypertension is crucial for improving patient care. Future quality improvement efforts should prioritize recognizing and managing secondary hypertension in primary care clinics.