Managing Asymptomatic Primary Hypertension in Young Adults: A Dual Approach

Young, asymptomatic primary hypertension?

Hello, doctor.
I am 24 years old and was diagnosed with hypertension at the age of 15.
Two years ago, I was confirmed to have primary hypertension.
I have undergone kidney MRI, echocardiogram, and exercise electrocardiogram, all of which showed no significant issues.
My biochemical test results and BMI (21) have always been normal.
I exercise regularly, maintain a normal diet, and have no discomfort.
However, my blood pressure was consistently above 150/90 before starting medication.
I have been taking Valsartan for two years now, and my blood pressure fluctuates around 130/80.
I would like to know if traditional Chinese medicine (TCM) could offer better management for someone as young as I am, or if I should continue with Western medication.
Previously, I consulted two TCM practitioners.
The first one, who is dual-trained in both Western and Chinese medicine, advised me to see a Western doctor, but I hesitated at that time.
Later, I visited a second TCM practitioner who suggested that I could hold off on seeing a Western doctor, but after taking scientific herbal medicine for two to three years, my blood pressure still fluctuates (above 145/85).
He also agreed that I should seek Western treatment, which I have been doing since then.

I understand that from a Western medical perspective, hypertension can be asymptomatic, and if it persists for 10 to 20 years, there is a significant risk of cardiovascular issues, which could become irreversible.
This is why I sought Western treatment.
However, I have heard that TCM can provide individualized adjustments.
Given my age, I believe there is a chance I could avoid Western medication, but my previous experiences with TCM have not yielded ideal control.
Therefore, I would like your guidance on whether treatments such as herbal medicine or acupuncture could be viable options.

Lan Mi, 20~29 year old female. Ask Date: 2018/03/26

Dr. Lin Qingzhong reply Traditional Chinese Medicine

Dear Lan Mi / 24 years old / Male netizen,
Hello!
1.
You are 24 years old and were diagnosed with hypertension at the age of 15, with primary hypertension confirmed two years ago.
This indicates that you are a young patient with hypertension, which may be due to genetic factors that are difficult to eliminate.
You will need to continue long-term medication and follow-up treatment.
2.
Continue to take the antihypertensive medication Valsartan prescribed by your Western medicine doctor, and monitor your blood pressure to keep it below 140/90 mmHg.
Your blood pressure control around 130/80 mmHg is good, as it reduces the risk of stroke and heart enlargement.
Continue to monitor your kidney function through MRI, cardiac ultrasound, exercise electrocardiograms, biochemical tests, and maintain a normal BMI (21), along with a balanced diet and regular exercise.
3.
Since you have been on antihypertensive medication for a long time, you may have developed a dependence on the medication.
It is important to continue taking your prescribed Western medication daily to control your blood pressure, which will help reduce the risk of stroke and ensure safety.
4.
Traditional Chinese medicine (TCM) involves diagnosis and treatment by a TCM practitioner, often tailored to the patient's constitution and clinical symptoms.
However, since you have been on Western medication for a long time, it is advisable to continue with your daily antihypertensive medication.
TCM or acupuncture may be considered based on your clinical presentation, in conjunction with Western treatment to improve other complications.
5.
It is essential to continue taking your Western medication daily to control your blood pressure.
Finally, I wish you well.
Director of the Traditional Chinese Medicine Department, Fengyuan Hospital / Associate Professor at the General Education Center, Chung Tai University of Technology, Lin Qingzhong, MD.

Reply Date: 2018/03/26

More Info

Managing asymptomatic primary hypertension in young adults, particularly in your case at 24 years old, requires a nuanced approach that balances both lifestyle modifications and medical treatment. Given your history of hypertension since age 15 and the fact that you have undergone various diagnostic tests (including MRI and echocardiograms) that have shown no significant abnormalities, it is essential to consider both conventional and alternative treatment options.

Understanding Primary Hypertension
Primary hypertension, often referred to as essential hypertension, is characterized by elevated blood pressure without an identifiable secondary cause. In young adults, this condition can be particularly concerning due to the potential long-term cardiovascular risks associated with untreated hypertension, even in the absence of symptoms. The fact that your blood pressure has been consistently around 130/80 mmHg while on valsartan indicates that the medication is effectively managing your condition, but it is understandable to seek alternatives, especially given your age and overall health.

Lifestyle Modifications
Before considering any changes to your medication regimen, it is crucial to emphasize the importance of lifestyle modifications. These include:
1. Dietary Changes: Adopting 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 saturated fats and cholesterol, can be beneficial. Limiting sodium intake to less than 2,300 mg per day (or ideally 1,500 mg) is also recommended.

2. Regular Physical Activity: Engaging in regular aerobic exercise (such as brisk walking, jogging, cycling, or swimming) for at least 150 minutes per week can help lower blood pressure and improve overall cardiovascular health.

3. Weight Management: Maintaining a healthy weight is crucial, as even a modest weight loss can significantly impact blood pressure levels.

4. Stress Management: Techniques such as mindfulness, meditation, yoga, or other relaxation strategies can help manage stress, which is a known contributor to elevated blood pressure.

Medical Treatment
While lifestyle changes are essential, your current use of valsartan, an angiotensin receptor blocker (ARB), is a standard treatment for hypertension. It is effective in managing blood pressure and has a favorable side effect profile. If your blood pressure remains stable around 130/80 mmHg, it may be reasonable to continue this regimen, especially since you have not experienced any adverse effects.

Considering Traditional Chinese Medicine (TCM)
Your interest in exploring Traditional Chinese Medicine (TCM) is valid, especially since TCM approaches hypertension with a holistic perspective. Acupuncture and herbal medicine may offer complementary benefits. However, it is essential to approach this with caution:
1. Consultation with Qualified Practitioners: If you decide to pursue TCM, ensure that you consult with licensed practitioners who have experience in treating hypertension. They can provide personalized treatment plans based on your specific constitution and symptoms.

2. Integration with Western Medicine: It is crucial to communicate with both your Western and TCM practitioners about your treatment plans. This ensures that there are no contraindications between the medications you are taking and any herbal remedies or treatments you may consider.

3. Monitoring: Regular monitoring of your blood pressure is essential, regardless of the treatment approach. This will help you and your healthcare providers assess the effectiveness of any new interventions.

Conclusion
In summary, managing asymptomatic primary hypertension in a young adult like yourself involves a dual approach that includes lifestyle modifications and careful consideration of medical treatments. Continuing with valsartan while implementing lifestyle changes is a sound strategy. Exploring TCM can be beneficial, but it should be done in conjunction with conventional treatments and under the guidance of qualified practitioners. Regular follow-ups with your healthcare provider will help ensure that your blood pressure remains well-controlled and that any necessary adjustments to your treatment plan can be made promptly.

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