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23, resistant hypertension.. Questions
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23, resistant hypertension.. Questions

Greetings Doctor,

I am a 23 year old male 200 lbs, 5,11 at age 21 I went to my doctors office and discovered that my systolic pressure was too high 160/80. Over the years I have begun exercising everyday, eating very little sodium etc. This did nothing and as of yet I have been put on 3 medications for my blood pressure.

1. Losartan Potassium 100mg
2. HCTZ 25
3. Toprol XL 25

Even with these medications my pressure at my last visit was even worse 168/70. My diastolic is always perfect. I must say this makes me feel hopeless and as if nothing can be done. My ENT suggested that I visit a nephrologist as he suspected a secondary cause due to my young age and resistance to three medications.  The nephrologist I saw is a very friendly older man, but very nonspecific. It seems he carried out a blood test for "VMA"? And Cortisol, he told me that both were too high "slIghtly elevated" but said he didnt suspect Cushings or Pheochromocytoma. When I asked why he just said that sometimes anxiety can cause lab error, etc and that the elevation was only somewhat above normal.

He didn't say much about my pressure during the visit and didn't give me any more medication. He did however ask me to do another Cortisol/VMA urine and blood tests as well as something called plasma ACTH. I have done several tests to rile out secondary causes they are as follows.

2x echocardiogram Normal
1x stress echocardiogram Normal
Kidney Ultrasound Normal
Adrenal MRI Normal

I have some questions I was hoping you could answer.

1. My doctor said that with the normal echocardiogram he believed it to be very unlikely I have true hypertension and wants me to do a 24 hour ABPM, why is this?

2. From what I have shared with you do you see any possible secondary causes? Isn't it unlikely for me to have excellent bp my entire life and suddey develop quite severe hypertension?

3. With all of the information on strokes and heart attacks I feel quite alot of worry regarding me possibly having one soon. My doctor said that even with my pressure high it would take decades for it to cause me a heart attack/stroke and to not worry. Is this accurate or need I worry about imminent death?

Thank you doctor; Dante


PS- Sorry for using doctor, I asked this on another board to a PhD, never got a response.
1124887_tn?1313758491
There are no doctors on this board, sorry, but I can try to give you some advice.

First, your hypertension is not severe. Your systolic pressure is mildly to moderately elevated. I completely agree with your doctor, do a 24 hour monitoring (I can't believe this isn't already done, after all the very advanced tests you have done). In my country that's the first thing a doctor will do when hypertension (or false hypertension / white coat phenomenon) is suspected.

I would also recommend asking for a carotid ultrasound, to find out if your blood vessels for some reason are stiffer than they should be. This can cause isolated systolic hypertension, but is EXTREMELY uncommon in young men (more common at age 60+). In young people, diastolic hypertension is more the rule than the exception. Isolated systolic hypertension is usually caused by stress / anxiety. How is your heart rate when your blood pressure is measured. If you are panicking and your heart rate is 120+, well, that's your diagnosis.

If you had a permanent blood pressure in the 160-170 range, your heart muscle would likely be thickened. The fact that it's not, is pointing very much in the direction of stress / white coat hypertension. Do the 24 hour test, and get the true answer when the test is complete.

Happy holidays

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