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Nephrology/Help me discover why I have such bad hypertension at 23?

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Greetings Doctor,

I am a 23 year old male 200 lbs, 5,11 at age 21 I went to my doctors office and discovered that my systolic pressure was too high 160/80. Over the years I have begun exercising everyday, eating very little sodium etc. This did nothing and as of yet I have been put on 3 medications for my blood pressure.

1. Losartan Potassium 100mg
2. HCTZ 25
3. Toprol XL 25

Even with these medications my pressure at my last visit was even worse 168/70. My diastolic is always perfect. I must say this makes me feel hopeless and as if nothing can be done. My ENT suggested that I visit a nephrologist as he suspected a secondary cause due to my young age and resistance to three medications.  The nephrologist I saw is a very friendly older man, but very nonspecific. It seems he carried out a blood test for "VMA"? And Cortisol, he told me that both were too high "slIghtly elevated" but said he didnt suspect Cushings or Pheochromocytoma. When I asked why he just said that sometimes anxiety can cause lab error, etc and that the elevation was only somewhat above normal.

He didn't say much about my pressure during the visit and didn't give me any more medication. He did however ask me to do another Cortisol/VMA urine and blood tests as well as something called plasma ACTH. I have done several tests to rile out secondary causes they are as follows.

2x echocardiogram Normal
1x stress echocardiogram Normal
Kidney Ultrasound Normal
Adrenal MRI Normal

I have some questions I was hoping you could answer.

1. My doctor said that with the normal echocardiogram he believed it to be very unlikely I have true hypertension and wants me to do a 24 hour ABPM, why is this?

2. From what I have shared with you do you see any possible secondary causes? Isn't it unlikely for me to have excellent bp my entire life and suddey develop quite severe hypertension?

3. With all of the information on strokes and heart attacks I feel quite alot of worry regarding me possibly having one soon. My doctor said that even with my pressure high it would take decades for it to cause me a heart attack/stroke and to not worry. Is this accurate or need I worry about imminent death?

Thank you doctor; Dante

Answer
Dante,

Thanks for asking my help on "Allexperts".

I would definitely rule out secondary hypertension for someone who is your age. Have your doctors done a doppler examination of the renal vasculature to rule out renal artery stenosis?

Your doctor probably ordered a 24 hour ABPM to rule out "white coat hypertension".

I don't think you need to worry about imminent death due to stroke or a heart attack. I agree with your doctor. The bottom line is to get your BP under good control. I would hike up the dose of your present meds or add new ones till I get you to your goal.

Sincerely,

Dr. Shah

Nephrology

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Dr. Shamik Shah, MD, DNB (Nephrology), ISN Fellow

Expertise

I can answer all questions related to kidney diseases, hypertension, plasmapheresis and kidney transplantation. I am an Indian-Board certified Nephrologist. I was a post-Doctoral Scholar at the Division of Nephrology & Hypertension,Department of Medicine, University of California, San Diego. My area of interest is Critical care Nephrology and Acute Kidney Injury.

Please mention the units in which your lab results were reported and the normal reference range for your laboratory.


Alternative Website
http://www.syndeohealth.com/doctors/shamik-shah/91

Experience

Ten years as a Critical Care & Transplant Nephrologist

Organizations
International Society of Nephrology
Indian Society of Nephrology
Indian Medical Association
European Renal Association


Publications
- Shah SH, Cerda J. Acute Tubular Necrosis; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4, pp. 191-198
- Shah SH, Cerda J. Management of Acute Kidney Injury; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4
- Cerda J, Tolwani A, Shah SH, Ronco C. Continuous Renal Replacement Therapies in Modeling and Control of Dialysis Systems edited by Azar AT, Springer-Verlag, Heidelberg, Germany (In Press)
- Shah SH, Cerda J, Kellum JA. Acute Kidney Injury in Special Circumstances. John Kellum, Jorge Cerda, eds. Renal and Metabolic Disorders, Oxford University Press (In press)
- Shah SH, Mehta RL. “Anticoagulation in CRRT: Is Citrate better?”; Vineet Nayyar Ed. Critical Care Update 2009, Jaypee Brothers (In press)
- Shah SH, Mehta RL. “Non-dialytic management of acute kidney disease”; Evidence based Nephrology, BMJ, (In press)
- Shah SH, Mehta RL. “Epidemiology of Community-acquired AKI”; Ronco C, Bellomo R, Kellum J Eds. Critical Care Nephrology, Saunders. ISBN 1-4160-4252-0
- Abdeen O, Shah SH, Mehta RL; “Dialysis therapies in the surgical intensive care unit”; William Wilson, Christopher Grande, David Hoyt Eds. Trauma: Resuscitation, Anesthesia, and Critical Care, Informa Healthcare, NY 2007. ISBN 0-8247-2920-X
- Shah SH, Mehta RL. Acute kidney injury in critical care: time for a paradigm shift? Curr Opin Nephrol Hypertens. 2006 Nov;15(6):561-5.
- Shah, SH, Soroko S, Lischer E, Mehta RL. Delivered vs. Prescribed dose of Dialysis in Hospitalized Patients: Results of an Audit. J Am Soc Nephrol 17(Abstracts Issue): 2006, 107A.
- Shah SH et al “Biochemical Nutritional Parameters in Non-vegetarian and Vegetarian CAPD patients” Perit Dial Int 2001; 21 Suppl 2: S1-182


Education/Credentials
MBBS, MD (Internal Medicine), Diplomate of National board (Nephrology), ISN Fellow

Awards and Honors
Educational Ambassador of the International Society of Nephrology 2010
Fellowship of the International Society of Nephrology 2005.
Young Investigator Award by the International Society of Peritoneal Dialysis 2001

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