26 y.o. high systolic, low diastolic-pulse pressure problem too?

Hi,

I'm 26 y.o. male, fit and in good shape. But a few months ago got a surprise at the doctor's with high BP readings.

I had a sonogram, and it turns out I have a kidney issue called UPJ stricture, caused by a vein pressing on the ureter. The doctor said it's best to just monitor it every year to make sure it doesn't get worse.

Anyway, I changed my diet, cut out salty foods, alcohol, exercised more, and got my bp to between 130 - 140 systolic. (I bought a BP monitor to home test).

Through reading online just found out about "Pulse Pressure" - the difference between systolic and diastolic numbers.

My systolic readings are between 130 - 140, but diastolic readings consistently around 70, which give me a "pulse pressure" of around 60 - 70.

I've read around 40 is a normal pulse pressure. What should I do? Is there a way to reduce my systolic bp, while keeping my diastolic bp at this level? Do I need medication like ACE inhibitors or something to properly reduce my systolic bp?

Thanks :)

[skydnsr]

I have the same issue with high pulse pressure (in my case due to bicuspid aortic disease).  I find that antihypertensive medication brings the systolic pressure down more than the diastolic.  You might be able to take something that would help.  As long as you are not feeling faint or having any other symptoms of hypotension, I think you are okay with a low diastolic, perhaps even a little lower than you are experiencing now -- as long as you don't get symptoms or functional problems from going lower.  I would start with a low dose of a first-line antihypertensive such as HCTZ and go from there.  Just run through the usual protocols, go slow and cautious, be aware of any hypotension symptoms, and see what happens.  Systolic readings of 130-140 are a bit high for a fit 26 year-old.  But what do your doctors think?  Do they think you are okay where you are, or have they suggested you try to further reduce the systolic?  I'm not aware of anything you can do to reduce the systolic without at least somewhat affecting the diastolic.

[Sam8383]

Hi, thanks for your reply!
I feel fine, no hypotension symptoms - and I'm trying to eat healthily etc to hopefully further reduce my systolic bp.

I'm currently living in a foreign, non-English speaking country. The doctor's just told me to be healthy, didn't mention anything about pulse pressure. They said I only need to take medication if my systolic bp was consistently over 150.

Just concerned that long term pulse pressure of 60-70 could be another problem.

Well, I guess I'll give it a couple of months and see what happens :)

[skydnsr]

I've had high pulse pressure for decades, and FWIW no doctor has ever mentioned to me that that in itself is a problem.  But at age 26, you have a lot of years of life expectancy left, and anything over 140 systolic is considered mild hypertension in the US.  Another 50 or 60 years of 140 systolic, even if it never goes any higher than that, is probably enough years of mild hypertension to do some damage.  On the other hand, 140 systolic isn't high enough that you can't wait for a while and see what happens.  You probably have years (I don't know how many, but probably quite a few years) that you could live at that level of hypertension before you started incurring damage.  You might try the DASH diet (www.dashdiet.org).  Good luck, I hope the systolic comes down and you don't have to worry or think about it anymore.

[skydnsr]

I'm not expressing myself very well.  Let me try one more time.  What I'm trying to say is, if you reduce the systolic, you will likely reduce the pulse pressure also, because anything that reduces your blood pressure will probably reduce the systolic more than the diastolic  -- and therefore you will have reduced your pulse pressure.  Again, I've never been told that pulse pressure, in and of itself, was anything to particularly worry about, but it has always been the case that whenever I have lowered my  blood pressure, the pulse pressure did end up being reduced also.  There.

[Sam8383]

Hi, thanks again for the input~
I've been on the DASH diet for 3 weeks... over the next few months gonna try to get my systolic down. And if I can manage that I think you're right - it'll reduce my pulse pressure too.
Don't know why I have high systolic bp - even before I found out I had it, I exercised regularly and had a pretty healthy diet. Well, I'm being really disciplined with my new lifestyle, so hopefully things will get better soon.

Cheers :)

[skydnsr]

Yes, it is very curious about your hypertension, with you being so young and fit.  The low diastolic suggests that you do not have a lot of plaque build-up on your arteries.  Something is driving the systolic up, but what?  There has to be an explanation.   I take it the doctor does not think your stricture has anything to do with it?  Or perhaps that is why you mentioned the stricture, because it does?

[Sam8383]

Hi again!
Well, that's good to hear I probably don't have a lot of plaque build up on the arteries (with low diastolic), interesting point.
It's encouraging to think there has to be an explanation... but indeed what is it? I had a sonogram to check if everything was ok with my heart/organs etc, that's when I first found out about the stricture! But the doctor said everything else was normal (heart rate, etc), and he didn't think the stricture was the cause.

Until I found out about my bp, I did like salty foods (didn't even know much about bp or the effect of sodium), so perhaps it's just diet? It is a bit puzzling though, as my wife eats similar things to me and her bp is fine.

Well, eating healthily now. Thanks for your thoughts :)

[skydnsr]

You know, the only thing I can say is that sonogram does not always detect a bicuspid aortic valve (BAV).  There are a large number of false negative echocardiograms for BAV.  I have bicuspid aortic disease, so I have read up quite a bit about it.  

Bicuspid disease is a syndrome and not just a valve defect.  It is thought to affect about 2% of the population, although not everyone in that 2% will progress to the point that they need intervention for it.  For some people, the valve defect is probably so slight that they go through life and never know that they have it.  The valve does tend to deteriorate over the years.  If someone has BAV, their chances of getting an accurate diagnosis will depend on the degree to which the valve deteriorates, as well as how thoroughly they are worked up.  A still-functional or somewhat functional BAV may not show up on an echocardiogram.  A very badly deteriorated BAV probably will.  So sometimes a first echo is negative, and then a later one will be positive, especially with an experienced tech and/or cardiologist who know what to look for.

It is typical for those whose BAV is till functional to appear very healthy and fit, at least until the valve deteriorates to the point that it starts causing problems.  BAV patients are typically diagnosed as adults.  Diagnosis in the 30's and 40's is very common, although some people are diagnosed as babies, and some people are diagnosed in their 50's.  Bicuspid people who get into their 60's without a diagnosis may have so much calcification that by that time that it is no longer possible to tell if the aortic valve is bicuspid or not.

Bicuspid aortic valve patients often have comorbid kidney abnormalities.  The most common type of renal anormality for someone with BAV is one or more benign kidney cyst.  (My right kidney is mostly a big cyst.)  I haven't ever heard of a stricture before, much less have I heard of renal strictures being associated with BAV, so I don't know what to make of that.    

I hesitate to even bring up the question of BAV, because chances are low that you have it.  It's not something to panic about, and it's not cause for thinking that you are not getting good care.  It is just something to keep in the back of your mind for later in life.  If I were you, and if my blood pressure did not get any better, and especially if got worse instead of better, then I would think a little more about the possibility of BAV -- because under those circumstances, you have no choice but to start investigating deeper.  Hopefully, your blood pressure issues will resolve, and you will never need to think about this post again.

In my case, my blood pressure was unusually low through my 20's, then I spent a a few years in the average BP range, and then suddenly I had systolic BP about 160.  (This is pretty typical with BAV:  unusually low BP early in life, then a transition to hypertension). No antihypertensive medication ever worked for me.  I finally discovered that I could keep my BP in the 140-ish systolic range by eating a low-salt diet.  Then, eventually, that didn't work anymore.  I started to stay in the severe hypertension range (averaging around 190/95 and oftentimes higher than 200/100).  Still, no medication could bring down my blood pressure to anywhere near normal, and the low-salt diet was not working anymore.

To make a long story short, I finally referred myself to a cardiologist who, first thing, did the most thorough auscultation for a murmer that I have ever had.  She listened to my chest with me in three different postures, with the stethoscope in about five different places on my chest, systematically covering all chest locations, both front and back, with me in all three postures.  There was a barely detectable murmer in one posture only, in one stethoscope placement only, on the front of my chest only.  

And that was how I found out that I had a heart valve problem.  I was 49 years old at the time I saw that cardiologist, and it turns out that the bicuspid valve was something that I was born with and had been living with all that time, and neither I nor anybody else ever knew about it until that day.  

So, yes, there is always a "reason" for anything.  We just don't always know the reason.  I finally found out the reason for my hypertension, or at least the reason why no antihypertensive medication was effective until after I had valve surgery.

BAV usually runs in families.  Sometimes there is a BAV patient who is the only person in their family with heart disease, but it is very common to have a history of either heart disease, sudden cardiac death, or aneurysm in the immediate or extended family.  It might not be a first-generation relative that has the history.  It might be an aunt, uncle, great aunt, great uncle, cousin, second or third or fourth cousin, grandparent, great grandparent, or great-great grandparent who had it.  Sometimes the affected relative was thought to die of a "heart attack," back in the days before we had caths or CT scans or echocardiograms or even EKG's.  

Well, I just felt it on my heart to share this information with you.  Quite likely, you don't have a BAV at all.  Maybe this will help someone else.  For anyone who wants more information about BAV or thoracic aortic aneurysms, a good source of information is www.bicuspidfoundation.com.

[Sam8383]

Hi,
Thanks so much for sharing about your experience. It's definitely something  I'll keep in mind as I monitor my bp progress.  Re: BAV's effect on kidneys, Dr. said my stricture is caused by a vein pushing against the ureter, so I don't think that's related to BAV. But, especially if I end up trying some kind of medication to lower my systolic bp a bit and it's not effective, I'll know to have the BAV properly checked up on.

It's strange, never imagined I'd be getting all worried about health issues. It's really great to hear your opinion and get some feedback/support/encouragement. Cheers.

[skydnsr]

You are thinking about the BAV information exactly the way I hoped you would.  If you ever have any questions, feel free to PM me on this site, and I will give you my email address.  Again, best of luck with this!

[skydnsr]

Check out this Wikipedia article, especially the paragraph headed Consistently High Values.  

http://en.wikipedia.org/wiki/Pulse_pressure

[Sam8383]

Hi again~ Thanks for the link - I actually came across that when I was doing a bit of reading about systolic bp, in fact that might be when I first heard about pulse pressure!

Have been working on getting on systolic bp down - good diet and exercise. Seen a bit of improvement. But heading off on a backpacking trip next week, so that's gonna interfere with my careful diet/exercise routine a bit I suppose...

Well, thanks again for the input and I'll be back to the board after 3 months!!   :)