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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 21, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 21, 2010
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High Blood Pressure |
Possible causes of secondary hypertension.08/21/2006 |
Hi. I am a 19-yr-old female, 166cm tall and 58 kg`s. I have been a regular blood donor for 2 years, with good BP record (110~120/70~80). About 2 weeks after my donation, my doctor noted me to have high BP 140/90 during a routine. ABPM of a well-rested day (no strenuous exercise etc) showed high readings generally, even when asleep. Highest was 166/128, while the lowest was 106/61. Pulse was generally high, with highest 166 and lowest 44.Parents both borderline hypertension (130~140/80~90) and after age of 45, while grandparents after age of 70.
Complete blood count normal except slightly raised ESR and WBC. No end-organ damage. Normal abdominal MRI although doctor thinks my adrenal gland is bulky. Normal heart echo (with trivial mitral regurtation and slight murmur), no hypertensive retinopathy (though there was nipping in the eyes). No Takayasu`s Arteritis. 24hr urine metanephrine was normal, although docs say the urine output (1.2 litres) was too little for 24 hours. During a recent hospitalisation for acute tonsilitis, urine noted to have +1 for protein.
Not stressed as on long term holiday and not working.
All doctors (physician, neuro, cardio, opthalmologist, endocrine) are pretty sure I dont have essential hypertension but don`t know what is my problem. Please advise on possible rare causes of secondary hypertension, and if its possible the problem was caught so early that other clinical signs may not manifest until later.
Am currently on 2.5mg Norvasc-BP quite controlled but it still rockets once or twice a day (5 readings everyday). I want to stop medication as I dont want to be popping pills fo another 50 yrs. Please advise again.
Thank you for your time. It is much appreciated.
It appears that you had a thorough work-up for secondary hypertension. It is true that secondary hypertension is more common in people who develop hypertension before age 35 and after age 55. However, the majority of people at any age with hypertension still have essential hypertension.
The most common cause of secondary hypertension is women is oral contraceptives. Most women who take oral contraceptives have a very slight rise in blood pressure. In rare cases, the hypertension can be severe. If you are taking them, you would have to stop this medication. If applicable, you also need a pregnancy test.
Another important cause of secondary hypertension is primary aldosteronism. If you have not been tested for it, you will need the plasma renin activity and serum aldosterone checked. This is a simple blood test, taken after 30 minutes in the upright position. You do not need to change your medications prior to this test. If positive, you would need a 24 h urine test for aldosterone.
Another, more rare cause of secondary hypertension is Cushing's syndrome. You would need a dexamethasone suppression test (a blood level of cortisol after taking a dose of 1 mg of dexamethasone). If not done, you need a thyroid function test (blood test).
You also need a 24 h urine for protein to screen for kidney disease, and, if indicated, a kidney biopsy.
If all these evaluations are negative, it is safe to assume that your hypertension is essential. You would have to take medications indefinitely.
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Max C. Reif, MD Director, Hypertension Section Division of Nephrology & Hypertension Department of Internal Medicine College of Medicine University of Cincinnati |
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