Barriers to Diagnosing and Misconception of Essential Hypertension

The systematic exploration of hypertension causes is often overlooked in clinical practice, leading to the classification of essential hypertension as the predominant "cause." The paradox is that most patients are diagnosed with essential hypertension, which prevents the identification of a treatable cause of hypertension, despite a condition with unknown causes being described as a prevalent cause of hypertension. The current review aimed to evaluate the cause of over-diagnosing essential hypertension. Increased awareness of this issue should enhance a systematic search for underlying causes, aiming to better manage high blood pressure and improve patients' quality of life.

Essential hypertension is defined as hypertension with an unidentified underlying cause, distinguishing it from secondary hypertension, where a specific cause is known. Diagnosing essential hypertension warrants a thorough search for potential causes; however, in practice, this search is often inadequate, even in countries with advanced healthcare systems. Several factors are responsible for this lack of investigation. Firstly, there is a prevalent misconception among physicians that secondary hypertension is rare, leading to a low prior probability of detection. This belief, reinforced by medical education and textbooks, results in doctors perceiving the search for secondary causes as time-consuming and unproductive. 

Secondly, the complexity of diagnostic procedures and the challenges in interpreting test results further discourage thorough investigations. Additionally, concerns about the implications of diagnosing secondary hypertension, such as the need for complex genetic testing in conditions like pheochromocytoma-paraganglioma, deter practitioners from pursuing a diagnosis. This creates a cycle of misunderstanding, leading to under-screening for secondary hypertension. Addressing this issue requires enhanced medical education, simplified diagnostic protocols, and reassurance about the benefits of identifying secondary hypertension.

Source: Rossi GP, Bagordo D, Rossi FB, Pintus G, Rossitto G, Seccia TM. 'Essential' arterial hypertension: time for a paradigm change. J Hypertens. 2024 Aug 1;42(8):1298-1304. doi: 10.1097/HJH.0000000000003767. Epub 2024 May 8. PMID: 38748508; PMCID: PMC11216381.