Streamlining diagnosis: role of ABPM and target screening in young-onset hypertension

Young-onset hypertension often coexists with metabolic syndrome. Accurate diagnosis is essential to prevent lifelong overtreatment. This audit evaluated diagnostic patterns, secondary hypertension screening yield, and the role of Ambulatory Blood Pressure Monitoring (ABPM) in patients under age 40.

A retrospective audit of 158 young adults referred to a cardiology hypertension service (Dec 2023 – May 2025) was conducted. Data on demographics, comorbidities, ABPM findings, and secondary workups were analysed.

The mean age was 29.5 years (56.3% female). High metabolic burden was noted: 80.5% had obesity or overweight and 30.4% had diabetes (highest prevalence in the Pakistani subgroup). Crucially, ABPM confirmed hypertension in only 55.3% of those tested, meaning 44.7% would have been potentially misdiagnosed via clinic readings alone. Secondary screening showed minimal yield (one case of primary hyperaldosteronism); however, obstructive sleep apnoea was identified as the most prevalent secondary contributor.

ABPM is essential to prevent misdiagnosis in young adults. Routine, broad secondary screening offers negligible clinical value compared to targeted investigation. These findings support a pharmacist-led pathway redesign focusing on ABPM-first diagnostics to ensure equitable, value-based care.

Metabolic Profile