Young Hypertension: Diagnosis and Testing Explained

Is this considered high blood pressure?

Hello Doctor: Starting from May 5th (Friday), I began to feel that my heart sometimes beats very fast, and I have a warm, tight sensation in my left chest.
On May 8th (Monday), I consulted a pulmonologist who measured my blood pressure twice, both readings were in the 160s, and my heart rate was in the 130s.
The doctor performed an electrocardiogram (ECG) and said it looked fine.
He also ordered blood tests to check my thyroid function and prescribed Inderal 10 mg, to be taken four times a day for a week.
Today, on May 15th (Monday), during my follow-up visit, my heart rate decreased, but my blood pressure was still in the 160s.
After reviewing last week's blood test results, the doctor confirmed that my thyroid function was normal.
A chest X-ray was performed, and the doctor stated that my heart and lungs appeared normal, diagnosing me with young-onset hypertension.
He then prescribed antihypertensive medication: Lercanidipine (Zanidip) 10 mg once daily and Concor 5 mg twice daily at 0.5 tablets each, to be taken for a week.
Additionally, he asked me to return on May 18th (Thursday) for fasting blood and urine tests, and on May 22nd (Monday) for a follow-up to review the results.
The lab tests include Glucose Ac, Creatinine, SGPT, LDL, Cholesterol, Triglycerides, Na, K, and Urine Analysis.
I would like to know if these tests are intended to assess hypertension or if they are for other conditions.
Furthermore, I want to ask if two blood pressure readings in the 160s are sufficient to diagnose hypertension.
The walk from the bus stop to the hospital takes about 3 to 5 minutes, and since the doctor measured my blood pressure directly without allowing me to rest first, could this have affected my readings? Should I consider visiting a larger hospital to consult a more specialized physician?

Dàxuéshēng, 20~29 year old female. Ask Date: 2017/05/15

Dr. He Dongjin reply Cardiology

Hello, you are correct.
Measuring blood pressure twice at 160-something does not definitively indicate hypertension; one cannot be diagnosed with high blood pressure based solely on two readings.
This condition requires lifelong medication, and not resting beforehand can affect blood pressure readings.
It is advisable to rest for at least 20 minutes before measuring.

For Lercanidipine (Zanidip) 10 mg, take one tablet once daily, and for Concor 5 mg, change from two doses of 0.5 tablets daily to one dose of 0.5 tablets daily.
Monitor your blood pressure for a while before making further decisions.

Testing for Glucose A1c, Creatinine, SGPT, LDL, Cholesterol, Triglycerides, Sodium, Potassium, and Urine Analysis should be routine checks and cannot determine the presence of hypertension.

Take care, and Changhua Hospital is concerned about your well-being.

Reply Date: 2017/05/15

More Info

Understanding young hypertension is crucial, especially given the increasing prevalence of high blood pressure among younger populations. The diagnosis and management of hypertension in young individuals can be complex, as it often requires a thorough evaluation to rule out secondary causes and to establish an appropriate treatment plan.

Diagnosis of Young Hypertension
In your case, the initial readings of 160 mmHg for systolic blood pressure and a heart rate of 130 bpm are concerning. However, diagnosing hypertension is not solely based on a couple of readings. According to the American College of Cardiology and the American Heart Association, hypertension is diagnosed when blood pressure readings are consistently elevated above 130/80 mmHg on multiple occasions. It is essential to measure blood pressure under standardized conditions, which includes allowing the patient to rest for at least 5 minutes before taking the measurement. Factors such as anxiety, recent physical activity, or even the white coat syndrome (anxiety in a medical setting) can lead to transient increases in blood pressure.

In your situation, the doctor performed an electrocardiogram (ECG) and thyroid function tests, which are appropriate steps to rule out other conditions that could contribute to your symptoms. The ECG showing no significant abnormalities is reassuring, and normal thyroid function tests help exclude hyperthyroidism, which can also cause elevated heart rates and blood pressure.

Further Testing
The additional tests your doctor ordered, including glucose, creatinine, liver enzymes (SGPT), lipid profile (LDL, cholesterol, triglycerides), sodium, potassium, and urine analysis, are not specifically aimed at diagnosing hypertension but rather to assess your overall metabolic and cardiovascular health. These tests can help identify risk factors for cardiovascular disease, such as diabetes or kidney dysfunction, which can be associated with hypertension.

Management of Young Hypertension
The management plan your doctor initiated, including the prescription of Lercanidipine and Concor, is a common approach to treating hypertension. Lercanidipine is a calcium channel blocker that helps relax blood vessels, while Concor (bisoprolol) is a beta-blocker that can help reduce heart rate and lower blood pressure. It is important to follow up with your healthcare provider to monitor your blood pressure response to these medications and adjust dosages as necessary.

Lifestyle Modifications
In addition to pharmacological treatment, lifestyle modifications play a critical role in managing hypertension, especially in young individuals. Recommendations include:
1. Dietary Changes: Adopt a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy while reducing sodium intake.

2. Regular Physical Activity: Engaging in regular aerobic exercise (e.g., walking, jogging, swimming) can significantly lower blood pressure.

3. Weight Management: Maintaining a healthy weight is crucial, as obesity is a significant risk factor for hypertension.

4. Stress Management: Techniques such as mindfulness, yoga, or other relaxation strategies can help manage stress, which may contribute to elevated blood pressure.

5. Avoiding Tobacco and Limiting Alcohol: Smoking cessation and limiting alcohol intake can also help lower blood pressure.

Conclusion
In summary, while your initial blood pressure readings are concerning, a comprehensive approach involving repeated measurements, lifestyle changes, and possibly medication is essential for managing young hypertension. If you continue to have elevated readings or if you have concerns about your treatment plan, seeking a second opinion from a specialist, such as a cardiologist or a hypertension specialist, may be beneficial. Regular follow-up appointments are crucial to monitor your condition and make necessary adjustments to your treatment plan.

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