young adult hbp

[ozark]

My son is 24yo, 6'5" 265lbs( his main weight is in his abdomen) diagnosed with hbp (160/100) 2 yrs ago. he was started on ziao (beta blocker and hctz)at a low dose and is now on zaio 10/6.25. He was not faithful with it until about 6 mo. ago. ..it now runs about 140's over 84-90. His lifestyle prior to the past 6 mo. was lack sleep (4-5 hrs), drinking, poor eating habits and caffeine. Now he sleeps about 8-10 hrs. doesnt drink as much only on weekends but not a lot, still doesnt eat right and still drinks caffeine sodas. He also smokes.
His morning bp is usually 140's/88 (before he goes to work) I took it once when he was sleeping and it was 120's/78-80, then another time 130/84. I take it sporadically maybe 1-2x a week.  the top number is usually in the 140's and bottom mid to high 80's. Occasionally i get 130/78-80 but that's unusual.
I'm concerned about the fact that it still really hasn't come down closer to normal in the past 2 yrs and the long term affects.  What is a normal bp for his size and first thing in morning? Is the bottom number too high?  His blood work is fine and cholesterol. I don't know why his dr chose this med and why it really hasnt changed, altho i trust his dr. Should i be concerned or is his bp ok?
thank you for your time.

[CCF-M.D.-MJM]

Hello,

It appropriate for you to be concerned.  The damage caused by high blood pressure is generally over the long term.  It is important to manage cardiac risk factors, it i will reduce the long term risk.

I'm concerned about the fact that it still really hasn't come down closer to normal in the past 2 yrs and the long term affects. What is a normal bp for his size and first thing in morning?

I don't think of it that way.  I blood pressure greater than 135/85 is boarderline and serial blood pressures over 140/90 is high blood pressure -- morning, noon or night.  If it is consistent, it is high blood pressure.

The most important thing for your son to do is stop smoking.  No one can do this for him and he needs to want and  believe it is the right thing to do.  Smoking is a decision with serious consequences.

Losing weight may help him decrease his blood pressure.

A diuretic like HCTZ is the first line therapy for high blood pressure.  After that you can choose medications based on other medical problems.  For somebody that is overweight and young, I would pick an ACE inhibitor like lisinopril (generic name).   Beta blockers can decrease energy and contribute to weight gain.  Sexual side effects are common and can lead to non compliance.

My advice is:
1. stop smoking
2. stop smoking
3. stop smoking
4. lose weight
5. diuretics first, if it alone doesn't work, consider a second agent with low side effects like an ACEI.  Beta blockers aren't a wrong choice, just a different choice.

Good luck and thanks for posting.



Is the bottom number too high?

[hbp702]

Normal BP for anyone, large or small is under 120/80. Pre-HBP is 120-139/80-89. Anything of 140/90 or above (always use the worst number) is full blown HBP.

Have him checked for sleep apnea.

[dquenzer]

My brother had high blood pressure at the same age.  Couldn't get into the military because it was too high.  He started doing aerobic exercises in his 20's.  It got to normal and he went off BP meds.  

I think your son will need to quit smoking and start exercising. The fact is that smoking affects BP, and a sedantary life makes it worse.

[Barbarella]

I know these are the new guidelines i.e. BP under 120/80, but it also depends on the doctor/cardiologist.  I agree a person in his 20's should have these numbers, but my cardiologist was very satisfied about my average numbers 130-140/80-85 ON BP meds, and taken at home and not at the doctor's office, and NOT when sitting quiet for 15 minutes, my cardiologist said "your daily life does not consist of sitting quiet for 15 minutes, I need to see how high your BP is without sitting quiet for15 minutes", he said "stop what you are doing, sit down and take your BP".  When I brought up the "new guidelines" he said "don't you worry about these new guidelines, you're doing great for your age", I'm 62.  When I saw our family doctor again who is NOT a cardiologist he said "these numbers are still to high", we need to bring them down. So now I sit quiet for 15 minutes (without his knowledge) and my BP is in the 115/75 range, and he is satisfied, and I got him off my back.

[Barbarella]

My last post above was meant for you and not for ozark.  Sorry about any misunderstanding.