Consensus of Multispecialty Experts on Clinical Screening for Secondary Hypertension in China (2023)
China has nearly 300 million hypertension patients, with 10-15% being secondary hypertension. The current awareness rate among Chinese hypertension patients is 47%, treatment rate is 41%, and control rate is 18%. Among adolescents with resistant hypertension, 40% have secondary hypertension.
Types of Endocrine Hypertension
Endocrine hypertension is an important component of secondary hypertension, primarily including:
Cushing's Syndrome Screening
Target Population for Screening
- Patients with progressive Cushing's syndrome clinical manifestations, especially those with typical symptoms such as central obesity, moon face, buffalo hump, flushed complexion, muscle weakness, striae, ecchymosis, thinning skin
- Young patients with osteoporosis, hypertension, or hyperglycemia inappropriate for their age
- Patients with obesity, type 2 diabetes, hypertension, osteoporosis, anxiety or depression
- Children with weight gain but decreasing height percentile
- Patients with adrenal incidentaloma or pituitary adenoma
Screening Method
Plasma cortisol levels show minimal difference between awake and sleeping states. Plasma cortisol <1.8 μg/dL (50 nmol/L) can exclude Cushing's syndrome, with diagnostic sensitivity of 96%-100%.
Technical Note: Clinical practice requires highly sensitive and specific detection methods to differentiate patients from non-patients. Mass spectrometry offers high specificity, high sensitivity, short analysis time, high automation, and high throughput.
Pheochromocytoma and Paraganglioma Screening
Catecholamines and their metabolites are important indicators for PPGL qualitative diagnosis. Currently, only mass spectrometry methods can achieve accurate detection.
Primary Aldosteronism Screening
Target Population for Screening
- Persistent hypertension (>150/100 mmHg) or resistant hypertension
- Hypertension with spontaneous or diuretic-induced hypokalemia
- Hypertension with adrenal incidentaloma
- Hypertension with early-onset hypertension family history or early-onset (<40 years) cerebrovascular accident family history
- First-degree relatives of PA patients with hypertension
- Hypertension with obstructive sleep apnea
Screening Method
Both domestic and international guidelines recommend using Aldosterone-to-Renine Ratio (ARR) as the primary screening indicator. ARR has high sensitivity for PA diagnosis and is simple, suitable for random outpatient testing.
| Screening Indicator | Recommended Method | Clinical Significance |
|---|---|---|
| Aldosterone/Renin Ratio (ARR) | CLIA or Mass Spectrometry | Primary PA screening indicator, high sensitivity |
| Plasma Aldosterone Concentration (PAC) | Mass Spectrometry (Recommended) | Avoids immunoassay cross-reaction, improves accuracy |
Special Note: Most PA patients have normal blood potassium; hypokalemia is no longer a reliable indicator for PA screening. Laboratories with conditions are recommended to establish mass spectrometry methods for aldosterone detection.
