Hypertension at age 20

[srk2780]

I'm a 20 yr-old female... 5'6" tall and 125 lbs... I feel that I eat pretty well, and I exercise for 45 minutes three times/week.  Last week I went to the doctor about a rash on my leg... while I was there, he discovered that my blood pressure was 139/92.  Later during the appointment, he checked it again and it was 142/92.  I went back on Monday, and my BP was 148/98.  At the doctor's office on Wednesday, my blood pressure was 160/882, and then later in the appointment it had gone down to 150/80.  I'm going back to the doctor on Friday for an additional check.

My grandmother and mother both suffer from hypertension, and I assumed that it might eventually be a problem for me... but never did I imagine I might suffer from it at my age.  Do you have any suggestions for helping me lower my blood pressure or any ideas of why it is so high?

[CCF-M.D.-KE]

Dear srk2780,

It sounds as if you have hypertension, which is defined as 2 separate blood pressure readings greater than 140/90. I would recommend that you avoid salt in your diet and start an exercise program. If this does not help you may need to be started on medication to lower your blood pressure.

Thanks for your question,

CCF-MD-KE

[cutestuff2]

Hi There!!  I read your post and would understand your being puzzled.  Since your Dr. took many readings, and you don't appear to be overweight and you exercise, I think your DR. would run blood and urine tests to check for thyroid and/or kidney probs.  If they are negative, he will prescribe a med and monitor you to see how your body responds to it.  It is possible to have hypertension at your age, not common but it happens.  I believe if you stay on top of everything, then you have nothing to worry about.  Maybe that rash was a blessing in disguise.  And.....to be hopeful maybe this is an isolated incident of hypertension due to stress.   Good luck, I wish you well.  Laura

[hbp702]

Don't accept a diagnosis of hypertension at age 20 without looking VERY closely at any possible causes.

Get a digital BP monitor ($60 or so at most) and take it at home. Let your doctor know what readings you get.

Have a FULL cardiovascular, renal and endocrine check!

I was diagnosed with HTN when I was 25. I am 29 now.

I don't have anything structurly wrong with my cardiovascular system and my kidneys checked out fine. I do have endocrine problems (insulin resistance, high-normal cortisol, severe male hypogonadism and high estrogen levels) which I am glad I found out about - because I felt terrible and was at risk for serious disease even if my BP was forced down to normal.

Life was no fun at all - they even had diagnosed depression - which went away as if by magic once the endocrine problems were controlled. The severe anxiety is also much lessened.

I am still on exceedingly high doses of 2 BP medicines even though the endocrine disorders are under control - the damage may have already been done - let's hope it is reversible. Let's hope nothing gets worse.

Doctors won't look very hard, they even make a diagnosis of essential/primary/idiopathic/we-don't-have-a-clue-why-you-got-it -and-we-don't-care-or-don't-have-time-to-find-out-why hypertension even in kids without much investigation.

DEMAND your doctors check for insulin resistance, cortisol excess, and any problems with levels of both female AND male hormones. DEMAND a captopril renal scan. DEMAND a stress test - to make sure your heart is okay.

Ask about Avandia if you have insulin resistance, even if you don't (yet) have diabetes. Insulin resistance can (and in my case) has done MUCH damage to the body's endocrine system. Eventually the pancreas can burn out (just like hypertension can cause heart failure, insulin resistance can cause pancreatic endocrine failure - i.e. diabetes).

Make sure any hormonal disturbances are PROPERLY treated!

Ask if you can exercise and how intense. Hopefully you can exercise vigorously, that (if safe for you) may be most helpful.

Don't permanently limit your exercise intensity UNLESS you get THREE medical opinions saying you must. Yes, I am suggesting a second and third opinion - many doctors are behind the times/over-cautious. Of course, be prudent until/unless you get a doctor's okay.

Pushing myself harder has resulted in significantly better BP control. Be safe, but don't give up.

- From someone who has been (and still is) there...

[debra21784]

Iam not in agreement with the last 2 responses.Am however in agreement with the doc on this forum.It is not always possible to find the cause of hypertension and even children can and do develop hypertension.There is a contributing genetic factor.Regadrless of the cause the B/P still must be aggressively managed to prevent damage to mutiple organ systems that can occur over time from the hypertension regardless of cause.The American Heart Association recommends that B/P be below 140/90 and even high systolic (top number)readings be lowered.
Diet with little to no salt,decreased fats and an exercise program are the mainstays of B/P management.If your doc is recommending B/P meds as well,it is sometimes feasible to take ,get the hypertension under control and then try backing off on the dose. Don't delay.Cardiac disease,renalfailure and stroke are all caused by contributing factors of hypertension and remember these disorders develop over a long period of time.Start now by prevention.

[hbp702]

First of all, I DID suggest she not only get one medical opinion, but if needed, up to three. I did suggest exercise, but ONLY with a doctor's ok.

Primary/essential hypertension used to never be diagnosed in those not yet in middle age, especially not in children.

Is it REALLY primary hypertension in these people under 30 that are getting diagnosed? Or is it secondary hypertension with a yet as unknown cause?

As for genetics, our genes can't have changed THAT much in the last couple of generations.

I agree hypertension needs to be treated. She needs to get EXPERT medical help. Yes, the sooner the better - not just because of the hypertension and the damage it causes, but also because of whatever else is wrong and the damage cause by that. She is too young for primary hypertension, unless the prevailing medical wisdom has changed drastically recently. Treating secondary hypertension as if it were primary means lifelong uneeded medication, loss of quality of life, and disease and death due to whatever the underlying cause of the hypertension is. Forcing someone's BP down to normal is not a victory over the disease - normal BP but with meds and no known cause is a partial defeat.

One should especially suspect secondary hypertension if there are any symptoms (hypertension is usually a "silent killer").

The medical community needs to find out WHY hypertension is skyrocketing and appearing in age groups it has not done in the past. Don't say it is all because of obesity, etc, they existed for ages in the US, but hypertension only got worse recently.

Way too many of our young people are chronically ill here in the USA.

Fat kids in the 50's (they did exist) didn't get hypertension, but apparently they are getting it nowadays. (same with type 2 diabetes) Same risk factors, I am comparing apples to apples. Maybe it is something in the environment...

She needs to get checked for lead excess too.

I have lost too many years of my life to being sick. If my doctor's and I had been more aggressive at looking for causes as quickly as possible, the last couple of years of my life and my life now would likely have been significantly better. Well at least the hypertension diagnosis did eventually get the ball rolling.

So I do have a very strong personal interest in this...

[hbp702]

It still might be white coat hypertension. Readings taken at home would be most useful to your doctors.

[RTFLY]

I agree a little with everyone. If I may ask srk2780, do you take any type of birth control meds? Also, a few simple lab studies may or may not point to a possible cause for your hypertension at such an age. I agree TOTALLY with the MD's suggestion in that a diet change and a good aerobic exercise regimen should help. You may not need any pharmacotherapy(meds)yet. I also agree with having a digital BP monitor at home so you can keep a log of how your doing. That will certainly be of help to your physician's when documenting any trends you may have. As long as your kidney function is normal, a diet rich in potassium may also help lower BP. The exact mechanism is still not clear, but potassium can cause vasodilation which may help in decreasing your BP. Again though...make sure your kidneys are OK before eating a bowl of bananas and watermelon! Getting your BP under control now is essential so that you won't have problems in the future. Take care and good luck...
                                                  JCI BS RRT

[srk2780]

Thanks for all of your comments and advice.  I went to my doctor this afternoon... my blood pressure was even higher than before (188/92).  He had be do lab work, chest x-rays, and an ECG.  Not all of my chemistries are back yet, but so far, I have an elevated blood sugar... 124.  He gave me a prescription for Atenolol (50mg).  We discussed my diet, and he said there is nothing I need to change, and he said that my exercise routine is fine (but I might have to cut back for a little bit, until I get adjusted to the medication).  I have to go back two times next week for more stuff.  Again, thanks for your advice.

[MacyMaid]

My daughter in law when she started on Birth Control Pills, raised her blood pressure.  Her doctor never asked her about Birth Control pills when her numbers were elevated.  When she got pregnant and off the pill, her BP was in the 120/75-80 range.

Another person I know had high BP.  Her doctor checked her for a condtion known as Pheocytoma (I am butchering the spelling but any physician would recognize my butchered spelling as to what this is) This conditon is a benign tumor causing the BP to get elevated.  This test is an easy one..Collection of urine in a jug for 25 hours.

Also, they need to check kidney functions. This also can cause elevated blood pressure.  

Good Luck and pls. keep us posted.

[srk2780]

I had my blood pressure checked today (I've been on atenolol for three days now).  My blood pressure was down to 133/82.  I have an appointment with my doctor on Friday to find out how the rest of my lab results are and to see what he might want to do next.

[pdh]

As has been said before, there are many reasons why you may have high BP and 90% of these reasons are unknown. Your doctor seems to have done the routine tests, and you still have more results to come back, so he may 'tailor' your medication to your needs and responses. I am 24 and have severe hypertension, and have had most the tests you have described which have come back OK. Sometimes you feel like a medical guinea pig, but it is a process of elimination. On 4 meds my BP has dropped from 220/120 max to an average of 160/100. These measurements were done in the docs office, BUT on my home machine I have got readings of 130/90 on average and when completely relaxed 110/70. Therefore my problem (I thinK)seems to be anxiety which in my opinion counts for a lot of the high readings in the Doc's office. However he has to prescribe me the drugs as that is the routine with readings that high, it is his job to lower it. But, after 6 months of this treatment I am being sent to a specialist who will get to root the problem once and for all. They have more means than your doctor to test these things and more knowledge (at least here in the UK). I am still convinced anxiety is the problem but they will find out for sure this time. You can only do it one step at a time.

BTW I am 5'11", 10 stone and eat healthily.

[Kymom]

I developed high blood pressure due to birth control pills...I was 22. Once I stopped pills, my bp was back to normal. When I was 30 it returned. I would say I suffer from "white coat syndrome" as well. I used to get pretty nervous about getting my bp checked that I would cause it to go up worrying about it. They generally would take it later on in the visit and it would come down. Now I take a daily reading and when I go to the office I don't freak out anymore.

I believe my bp is due to heredity. My grandparents and parents both have this. My brother got it when he was 22, fit as a fiddle. The people who have this in my family are from the most fit to most unfit and eveyone in between.

So, there are many reasons why people have this, some underlying and some unknown.

Best of luck to you. You are doing the right thing in getting it treated.