hypertension in someone young and healthy

March 4, 2009 11:59 AM

I'm 23 and I've just been given a diagnosis of essential hypertension and I've been put on meds. My doc says it's not a big deal at my age as long as I control it...really?

My readings at Kaiser have been just around the 140/90 mark, and I've had a few home readings just below that. I am skinny, don't smoke, I eat organic produce from my CSA box, I have a desk job that I commute to by bike 15 min each way, 5 days a week. I get a little extra exercise here and there like hiking on weekends. Both parents have had normal or low BP readings in the last few months.

I'm having a hard time with the "essential" part of the diagnosis; it seems like someone with my lifestyle and background should not have it this young. Yes, I know it's getting more common, but I'm not a typical fat, unhealthy American, so why me? Doc says it's "genetic" and that secondary causes are vanishingly likely. This all seems hand-wavey and unsatisfying. I plan to make my exercise longer and more intense, but I'm worried it won't be enough. Anything else I can do to avoid a lifetime of meds, or short of that, things I can read so that I know what I'm getting into?

posted by slow graffiti to health & fitness (19 comments total)

...it seems like someone with my lifestyle and background should not have it this young.

That's why it's called "essential". I was on BP meds (enalapril, mostly) for a long time (complicated backstory, should probably still be on them) and they didn't bother me at all. Zero identifiable side effects. High blood pressure is like cholesterol and blood glucose levels: just something to keep an eye on. IANAD, but if mild essential hypertension is all that's going on with you, the consequences are likely nil.
posted by Inspector.Gadget at 12:06 PM on March 4, 2009

My doc says it's not a big deal at my age as long as I control it...really?

Really.
posted by zoomorphic at 12:08 PM on March 4, 2009

Oh, in terms of bringing it down: watch your sodium intake and see if that makes a difference. As a bonus, a reduced salt intake allows you to taste flavors that would otherwise be overwhelmed by salt and lets you use a relaively small amount of salt to great effect in certain dishes. I found that cardiovascular fitness and fluid intake also affected my BP, and it dropped slightly when I was doing a lot of weight lifting for about 2 years.
posted by Inspector.Gadget at 12:09 PM on March 4, 2009

Hypertension isn't always caused by negative health factors like obesity, excessive sodium, etc. Some people just have high blood pressure. You seem to be one of them. It happens. With proper management--the exercise and dietary recommendations are good, but meds are going to be important--this doesn't need to be a significant risk factor for you.

If this is the only "major" inherited health problem you've got, you're coming out rather well.
posted by valkyryn at 12:10 PM on March 4, 2009 [1 favorite]

I have to wonder though -did the doc have you take your BP various times over the course of a few days? Some people experience a bit of an elevation in BP while at the doctor's office. Ask about it, it may show something different.
posted by kellyblah at 12:35 PM on March 4, 2009

I started taking an ACE inhibitor for hypertension when I was 22, and added a diuretic a few years later. I had single-digit body fat thanks to swimming and weight lifting, and ate a healthy diet. In my case the genetic link was pretty clear, since both of my parents are also on meds. You're definitely not alone.

Never any side effects from the ACE inhibitor. The diuretic made me visit the mens' room more often at first and lowered my alcohol tolerance, but those effects went away after a couple of months. The diuretic has a plus as well: I don't hold onto any water weight. Bodybuilders often abuse diuretics for this reason.
posted by Thoughtcrime at 12:38 PM on March 4, 2009

When reading your question, I wondered the same as kellyblah did. 140/90 isn't horribly high. I was very surprised you were put on meds for that and the doctor didn't have you try some lifestyle and/or diet changes first - eat more oatmeal, exercise more, etc.

Some might even consider that read within a borderline healthy range -IANAD of course, but this is something I've noticed in reading about bp. For the most part, my blood pressure is on the low end of normal, but every so often at the doctor's, I'll get a reading of 140/x or so. You could be stressing over it enough to cause a mild anxiety reaction.

Get a second opinion.
posted by cmgonzalez at 12:50 PM on March 4, 2009

Deadlift more.
posted by tiburon at 12:56 PM on March 4, 2009

I got put on meds for the same thing around age 30. Some years later, it still bothers me to have something "essential" that requires medication - I constantly wonder if the 120/80 standard is really that accurate across all populations, body types, genders, age groups, etc.

One thing I wanted to to point out is that sometimes there can be an underlying cause, such as renal arterial stenosis, so if your doc hasn't checked things like that out, he/she probably should. Have you had a CT scan for that?

As far as lowering it without meds - I'my attempts to exercise, yoga, reduce stress, etc have been pretty unsuccessful, but adjusting my diet has helped. The lower my carbohydrate consumption is, the lower my BP is - but still not low enough to go off meds :(
posted by chez shoes at 1:19 PM on March 4, 2009

I have this too despite a reasonable diet and regular workouts. I take an ACE inhibitor and a diuretic and like Thoughtcrime I have no obvious side effects.

My doctor and I watched it climb slowly over a period of years. I only started on the meds when they updated the definitions of what high blood pressure was and I was rejected by the Red Cross when trying to give blood.

Considering the damage high blood pressure can do over the years, it's worth treating even at your age. Your doctor will want you to get blood tests done periodically to make sure your potassium levels aren't getting too low. Luckily it's easy to get potassium in your diet.

As far as whether or not this is genetic, no one in my family but me has it.
posted by tommasz at 1:34 PM on March 4, 2009

I am a fat American who, like much of my family, has low to normal blood pressure. My husband is a fit, healthy American who, like much of his family, has high blood pressure. Genetics can be a bitch.

My husband's managed to keep his blood pressure below hypertensive levels by doing much of what's described above re: diet and exercise. He also takes a fair amount of garlic daily. While the clinical data apparently isn't all rosy, in his case, that has appeared to swing the difference between meds and no meds.
posted by gnomeloaf at 2:15 PM on March 4, 2009

Also essential diagonsis when I was in my mid-20s. Been on an alpha- and beta- blocker until I got pregnant, then switched to other things. Never had side effects. Like you, I was around 140/90 when they put me on the drugs. However, they only did that because I was complaining of dull headaches over quite a long period of time, and only after they did a whole bunch of tests to rule out other reasons for the HBP (including an MRI, possibly of my liver? I actually forget why.) So, you aren't alone.

The only issue that has come up for me has been related to pregnancy. If you have specific questions about that, feel free to let me know!
posted by dpx.mfx at 3:10 PM on March 4, 2009

I have had hypetension, which got worse over time, since I was 16. I'm not a typical fat, unhealthy American. I have seen a few doctors about it (I am 33 now) and after running a battery of labs and tests, it was determined that I just have it. Probably genetic, but still, it's nothing I did. I'm on meds, and as long as the BP itself is controlled, there is nothing to worry about (according to my doctors and the literature I have read on the subject). Did your doctor run any kind of tests on you to see if a cause could be determined?

However, 140/90 doesn't seem high enough for meds? There might be diet or lifestyle changes you could make first - less sodium, more exercise, for example. Also, maybe you could take a handful of trips over to a pharmacy and stick your arm in the BP machine to see if the readings are consistent at 140/90. You might have "white coat" syndrome, which just means that being in a dr's office makes you stressed, therefore raising your BP. In any case, I agree with the poster above who suggested a second opinion about whether meds are necessary right away, or if there are lifestyle changes you can make first.

Also, once on meds, try to keep monitoring your BP to see if you notice any changes that may require a modification to your BP. I started out at about your range, and got progressively worse over time until it kind of stabilized at a particular level.
posted by DrGirlfriend at 3:13 PM on March 4, 2009

My grandfather is a former marathon-running mountain trekker who eats extremely healthily and doesn't smoke. He has high blood pressure, just like pretty much everyone in his family, regardless of how healthy they are otherwise. Some people just have it. He is in his late 60s and still hikes large mountains. It hasn't impacted his life much other than restricting sodium and taking meds.
posted by fructose at 3:54 PM on March 4, 2009

How long a period of time were those readings taken over? I agree with others who say that a reading of 140/90 doesn't seem high enough for medication, but if you got those readings for a year or more - which I did - then it's worth it. As others have pointed out, a lot of people get higher readings at the doctor's office. My doctor's monitor is a sensitive digital one and it gives me a higher reading if I am talking to her at the time. They hooked me up to a 24-hour portable monitor which showed I did have sustained mild hypertension, even after six months of healthier eating and exercise. You might want to see if you can get the same thing. In my case, I also got a few other tests (ECG, echocardiogram, blood tests) which showed that my hypertension had led to left ventricular hypertrophy, which is one of the things that can happen if it's untreated.

If it's genetic or stress-related the extra exercise may not help, but the good news is that it really is no big deal if you control it. I've been on medication (perindropril) for a year now, notice absolutely no side effects, and my BP is consistently textbook normal.
posted by andraste at 4:16 PM on March 4, 2009

Another Random Data Point: I never drink 'enough water' to satisfy fitness people, but if I'm specifically concentrating on hydrating myself, my BP is always lower than it usually is.
posted by Weighted Companion Cube at 5:35 PM on March 4, 2009

140/90 isn't horribly high.

I constantly wonder if the 120/80 standard is really that accurate across all populations, body types, genders, age groups, etc.

The new thinking is that even 120/80 is borderline high.
posted by brevator at 5:36 PM on March 4, 2009

Since both your parents have normal or low blood pressure readings, it doesn't seem like yours being high would be genetic. You might want to have your doctor test your kidney function just to be safe. It's not that expensive and it's good to rule out if there are no other obvious causes. The advice about cutting out salt is also really good. Many people are salt sensitive and cutting back or out salt can help get your bp back down.
posted by stray thoughts at 1:35 AM on March 5, 2009

Are you in the UK? THey changed the definition - I am 140/90 and suddenly I was being medicated etc. I actually resisted it for a long time, got fitter, did even more of the dietary things you do - had all the tests on liver, kidney etc funtion and, well I just have it. About to go on a drug, can't remember the name right now. THere are lots to choose from, so if you do get side-effects, tell the doc and they can try a new one. And watch the dose you're put on - they are meant to start it low and build up.

Good luck!
posted by LyzzyBee at 3:13 AM on March 5, 2009