Expert: Newell R. Falkinburg, M.D. FACP - 4/16/2008

Question
QUESTION: I am a 23 years old male and couple a weeks ago I found out that I have a high blood pressure.I have been working out for about 5 years now and I used many different supplements like creatine, protein, amino acids and caffeine staff. Three weeks ago I didn;t feel good and I went to the ER cuz my BP was 150/98 and they did a blood test and said that I am ok and there is nothing wrong with my kidneys, heart, liver and I am healthy, but couple a days after same thing happend and I had to go back to the ER with the same BP readings. I got very scared, they checked me out again and they said anxiety is the problem. The doc gave me some kind of pills for the anxiety and said that I ll be fine .Next day I called cardiologist and went to see him, he sent me for additional blood tests and urine tests and EKG and ECHO cardiogram also. When the results came he called me and he said that everything is compliteley normal. I stoped all supplements and work out. My BP is stil going up and down

ANSWER: Dear Lou,

There are two kinds of hypertension, primary (which is the most common) and secondary (which is uncommon).  Primary (also called "essential") hypertension  has no specific cause, tends to begin in one's thirtys and forties and is asymptomatic.  All forms of hypertension are asymptomatic and do their damage silently by causing the arteries of the body to wear out faster than normal.  This process is called accelerated hardening of the arteries. Clinically, this results in stroke, kidney failure, heart attack and conegstive heart failure.  Keeping the BP below 140/90 prevents this.

The most common CAUSE of secondary hypertension is kidney disease.  Other causes are several types of noncancerous tumors of the adrenal gland that produce hormones that cause the BP to go up.

Because you are on the young side to be developing hypertension, you need to have these secondary causes ruled out.  This is done by having a urinalysis, kidney function tests, blood electrolytes, A blood test called free metanephrines and another blood test called a plasma renin:aldosterone ratio. A narrowing of the artery supplying blood to the kidney can also cause high blood pressure and, although in your case it would be very unlikely, it should be ruled out.  This is done with a test called a doppler rem]nal artery ultrasound.  You need to have all these tests done.  If they are all normal, then you have essential hypertension as do 20 - 50% of americans. The incidence is higher in Blacks and the hypertension is generally more severe in Blacks as are its consequences.

Anxiety, per se, is not a cause of hypertension and antianxiety drugs should not be prescribed to hypertensive patients rather than giving specific antihyoertensive treatment.  Having said that, drug  and alcohol abuse are causes of and aggravating factors in hypertension and if this is an issue in your case you need to take appropriate action. Obesity is also an aggravating factor in hypertension and achieving one's ideal body weight is very helpful in treating hypertension and occasionally, such patients can go off their medications for variable lengths of time.

It is very likely that you are going to require medication to adequately control your blood pressure.  If you are Caucasian, I would begin you on lisinopril 5 mg/Day, increasing every two weeks to a max of 20 mg/D.  If further medication is required, I would add hydrochlorthiazide 12.5 mg/D increasing to a max of 25 mh/D in two weeks if necessary.  This regimen has a 90% chance of controling your hypertension. There are many other medications available to add if it is necessary but the point of paramount importance is to get your BP BELOW 140/90.  I like mine less than 120/70.  It was 116/56 this morning when I went to the gym to work out.

I would continue your exercise program because to will make your BP easier to control and it's fun.  I would also go on a 4 gram (no added salt) sodium diet because this will also make your BP easier to control.

Do the above and you'll live to be an old geezer like me and have a great life.

Hope this is helpful to you and thanks for the question.

Sincerely,

DR. Falkinburg

---------- FOLLOW-UP ----------

QUESTION: the doc from the ER gave me 1mg Xanax but I m scared to take them.. when i take one my BP goes down so I don know what to do .At the hospital they did a lot of blood and urine tests and they said everything is completely normal but my good cholesterol level was 28 and my bad cholesterol level was 160..please give me an advice

Answer
Dear Lou,

Good to hear from you again.

Xanax is a mind altering very addicting medication that has no place in the treatment of hypertension.  The ER doctor should know better than to prescribe it for hypertension.

I strongly advise youto get a real doctor...ideally a specialist in internal medicine or a nephrologist to evaluate and appropriately treat your hypertension.

Nervousness is NOT a CAUSE of hypertension.  This is commonly thought to be the case because the  word "tension" is contained within the word "hyerTENSION". The word "tension" contained in the worsd hypertension refers to the tension within the arterial walls.  This is high and results in the high blood pressure.

In fact, tension or anxiety may be an aggravating factor in the management of hypertension but it is not the cause.  The bottom line is that you need antihypertensive medications to properly treat your hypertension not antianxiety drugs.

My advice is to throw away the xanax and get a "REAL" doctor to properly treat your hypertension. You also need to have your high "bad" cholesterol treated with diet and possibly medication.

THanks for the follow up.

Sincerely,

Dr. Falkinburg