Doc: Lifelong hypertension likely has underlying cause
Dear Dr. Roach: My daughter’s blood pressure has been high since she was 14, and she is now 43. Her blood pressure recently has been 210/142, and she is having trouble getting it down. She has seen several doctors, and none has an answer.
Dear J.E.: There are two big warning signs in your story. The first is that the high blood pressure began so early, and the second is that it is so very dangerously high. This raises the suspicion that there might be an underlying cause for her high blood pressure.
One of the most common “secondary” causes in younger people is fibromuscular dysplasia, a condition where the blood vessels to the kidney have a muscular ring, which reduces blood flow to the kidneys. They, in turn, secrete a substance (renin) that increases blood pressure.
Another is pheochromocytoma, a tumor of the adrenal gland that secretes epinephrine and related compounds. These directly increase blood pressure.
Conn’s syndrome is another type of tumor, this time secreting aldosterone.
Then there is obstructive sleep apnea, Cushing’s syndrome (excess cortisol) and coarctation of the aorta, which I would be very concerned about in someone who had high blood pressure so young.
A coarctation is a partial blockage in the aorta (the major artery in the body). It occurs sometimes between the blood vessel going to the left arm and that to the right, and sometimes between the blood vessels to the arms and those to the legs. Thus, in a coarctation, there is always a big difference in the blood pressure of the arms and that of the legs, and sometimes a big difference from one arm and the other.
This list of secondary causes is not exhaustive: certain medications (oral contraceptives, for example) can cause high blood pressure, as can recreational drugs, especially cocaine.
Given the severity of her blood pressure, she should see an expert in hypertension. This specialist often has additional certification in kidney disease or heart disease.
Dear Dr. Roach: I have an observation: To properly utilize the doctor’s time at an office visit, the patient bears a responsibility to prepare. Bring a list of medications, including those taken over the counter and vitamins. Have a printed summary of symptoms and problems since the last visit, including adverse effects of medications. Prepare a medical history with dates: surgeries, hospitalizations and cause, and significant family history. Bring a living will with designated durable power of attorney for health care (also called a proxy). Write your questions; example: “When should I go to the ER?”’
Your doctor and office staff will be most appreciative. Our excellent internist is, and we receive appropriate and timely care.
Dear W.A.K.: I agree completely. Preparing for a doctor’s visit, particularly the first one or an annual checkup, makes the time spent more efficient and productive. I have had patients with hypertension come in with written daily records of their readings, and a few patients with diabetes come in with beautifully recorded blood sugar levels arranged by time of day, with ranges and averages recorded (I have a few patients who are engineers by profession).
The more complete the information your doctor gets, the better the decisions your doctor is likely to make.
Email questions to ToYourGoodHealth@med.cornell.edu.