# Acute Hepatic Porphyria Should Be Included in the Diagnostic Work-Up of Patients with Resistant Hypertension or Suspected Secondary Hypertension

## TL;DR

This paper argues that Acute Hepatic Porphyria should be considered in patients with resistant or secondary hypertension due to its potential for early treatment.

## Contribution

The paper highlights the under-recognized link between Acute Hepatic Porphyria and resistant hypertension.

## Key findings

- AHP can present as both acute and chronic hypertension.
- AHP is a treatable metabolic disorder often overlooked in hypertension evaluations.
- Including AHP in diagnostic work-ups could lead to earlier treatment.

## Abstract

Secondary hypertension and resistant hypertension may result from potentially treatable acquired or hereditary diseases. Inherited Metabolic Disorders are not routinely included in the differential diagnosis of these contexts associated with hypertension, despite the key importance of diagnosis for several of them which enable the early treatment of them. We aim to discuss the current evidence that indicates that a significant portion of cases of unknown resistant hypertension or suspected secondary hypertension may result from unrecognized Acute Hepatic Porphyria (AHP). Diagnostic work-up for AHP is not routinely performed during the evaluation of patients with resistant or refractory hypertension nor in the investigation of secondary hypertension. AHP may present both with neurological and systemic involvement, and hypertension may be observed as part of acute dysautonomia during acute neurovisceral attacks and as a chronic complication during disease course. As AHP represent a potentially treatable group of metabolic disorders, clinicians should consider the inclusion of this group in the diagnostic evaluation of patients with secondary or resistant hypertension.