When is it appropriate to consider a diagnosis of secondary hypertension?

Considering a diagnosis of secondary hypertension is particularly warranted when hypertension presents at a known onset before the age of 30. This early onset can be indicative of underlying conditions that may be causing the hypertension, such as renal artery stenosis, primary hyperaldosteronism, or other systemic diseases. Early-onset hypertension tends to be less common and not typically associated with primary hypertension, which generally develops later in life.

In this context, secondary hypertension refers to high blood pressure that is a result of another medical condition. The association of hypertension with a younger age can trigger a more thorough investigation into potential secondary causes rather than assuming it is primary hypertension, which often has no identifiable cause.

The other scenarios—stable hypertension in young adults, hypertension only observed during exercise, and hypertension that resolves with rest—do not typically suggest secondary causes. Stable hypertension in young adults could still be primary in nature. Exercise-induced hypertension is often a benign phenomenon and may not require extensive investigation. Lastly, hypertension that resolves with rest could suggest a physiological response rather than an underlying pathology, which is less indicative of secondary hypertension. Therefore, identifying early onset as a marker for secondary hypertension is crucial in clinical practice.