27 yo male - recently diagnosed high BP/ possibly enlarged heart

[Edie__0]

  I'm a 27 year old white male, about 15 lbs overweight (accumulated over last two years)  and have not regularly exercised for a couple of  years. I have never smoked. . I work in a stressful professional job which often entails long hours/travel. No direct (mother/father/sibling) history of high BP although grandparents have had various heart conditions (angina etc) in their late years.
  While on a business trip in the US, I suffered a nasty ear infection through fluid in the inner ear. A local MD took my BP as part of a routine exam  and found it to be 190/120.  At this point, I was stressed out having only slept 5-6 hours over the last two days + inter-continental flight and work pressure. Also I had taken four Tylenol decongestant tablets earier in the day (which apparantly can raise BP). Heart was racing (120bpm).
  I returned 24 hours later to find that BP was little changed and the doctor prescribed metroprolol until my return to the UK a few days later. This maintained my bp at normal rates and pulse at 60 bpm on 100mg/day. They did make me feel odd though with occasional flushing.
  My own doctor in the UK asked me to come off the pills on my return to establish my baseline BP. I have also switched to a low fat diet and undertaken a program of moderate aerobic exercise plus relaxation techniques (deep breathing exercises etc etc). over the last week. I am taking calcium and magnesium supplements (800mg of each at night + 400 mg of each in the morning).
  . I have taken BP regularly with Omron digital home device and found it to vary between 137/70 and 160/100 but usually around 150/90. This has been while at home away from a stressful environment. Resting heart rate seems to be about 80bpm. Consistently higher in the doctors office (160-170/90) - I think this may be anxiety about being there in the first place!
  I have felt no symptoms  in particular except for a slight pull at my left chest which comes and gos for a few days at a time and does not increase with physical exertion (last 6 months or so). I've also noticed that my heart rate is increased for periods (c 100bpm) - although this seems to have stopped with the resumption of regular exercise.  No problems in carrying out 30mins of exercise (rowing, cycling or swimming) at moderate resistance/speed at 75% target heart rate.
  I have had a resting ECG and appropriate blood tests. Blood tests were all normal but doctor says that ECG suggests a mildly enlarged heart.
  I do not particularly want to restart the BP medication and would prefer to try and tackle it via lifestyle change(diet, stress reduction, exercise)  -  I hope I can get the systolic down to 140 or below in this way and wold like to give that a try for three months.  Is this likely to be achievable?
  Can an enlarged heart be diagnosed from an ECG - I thought an electrocardiogram or similar was required. If so, why would a doctor conclude this from an ECG? Does this slight pull in my chest indicate an enlarged heart or anything else in particular? I'm suprised that my heart could have been affected this way given my age and good health to date.
   If my heart is enlarged, is this reversible? (I have seen conflicting comments on this).
  Could there be any relationship between an enlarged heart and my ear infection (which is pretty much gone now). I have heard that an enlarged heart in combination with even mildy high BP is dangerous - can you confirm/deny?
  Lastly, I have heard that Diovan(valsartan) is an effective BP medication while being more effective than other in reversing ventricular hypertrophy and having very few side effects. Also that captopril, while more expensive, has fewer side effects than metroprolol. If I have to go on medication can you suggest which medication would be most effective with minimal side effects...
  Sorry for the barrage of questions but I prefer to try and take as much responsiblity as possible for my own well-being.
  
  With kind regards
  Eddie

[CCF CARDIO MD APS]

_
Dear Eddie,
It is certainly your choice to try everything but medications to lower your
blood pressure to normal levels (less than or equal to 140/80).
The ecg is non-specific and so technically you can not say for sure from an
electrocardiogram (ecg) that the heart is for sure enlarged, however, an
echocardiogram (ultrasound of the heart) can definitively diagnose a heartj
as being enlarged (if it is the heart muscle that is enlarged, this is called
hypertrophy, and if the left ventricular chamber is enlarged, this is called
dilated cardiomyopathy.)  Untreated hypertension can cause either of these types
of heart "enlargement".
I might be able to answer your other questions if I knew which type of "enlargement"
it was that you are talking about, but regardless, your latter questions are
delving in to the diagnosis and opinion type of questions that are inappropriate for
this informational forum.  As well, different medications have different side effects
in everyone and it is therefore completely unpredictable which would be best for you.
If and when you and your physician decide that you need blood pressure medications to maintain
a "normal" blood pressure, work with that physician to determine which drug works best for you.
It is highly unlikely that your "enlarged" heart is related in any way to the ear infection.
As for the dangerousness of high blood pressure alone, let me just say that it
is the cause of much of the heart disease and strokes in this country.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!