Hypertension at 50

ON CALL

June 15, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: My blood pressure was always normal until I turned 50. When my doctor discovered the high blood pressure, he ordered a lot of tests before starting to treat me. I am upset by the costs of these tests and wonder if they were necessary. My friends with high blood pressure were not subjected to expensive tests; they were only told to lose weight, watch the salt in their diet, and then were started on some pills.

A: About 95 percent of people with high blood presure have primary or essential hypertension, which means that no explanation can be found for their hypertension. Your doctor probably thought that you might have the less common secondary hypertension, and did extra tests to confirm his suspicions.

Secondary hypertension results from a disorder or drug that raises blood pressure. Kidney disease leading to chronic renal failure almost always produces hypertension due to excessive retention of salt and water in the body. Narrowing of the arteries to one or both kidneys reduces blood flow to the kidneys and causes a form of high blood pressure called renovascular hypertension. Sensingthe inadequate blood supply, the affected kidney secretes too much renin, an enzyme that helps form a product that raises blood pressure by constricting small blood vessels and promoting the retention of salt and water by the kidneys.

Adrenal tumors can cause hypertension. Also, a narrowing of the portion of the aorta within the chest (coarctation of the aorta) is linked to hypertension in the upper part of the body and low blood pressure in the abdomen and legs. This disorder is most likely to be discovered in young people.

Drugs that can raise blood pressure include corticosteroids, cold remedies, nasal decongestants, appetite suppressants, nonsteroidal anti-inflammatory drugs, cyclosporine, erythropoietin, monoamine oxidase inhibitors and tricyclic anti-depressants.

These secondary causes of hypertension must be considered in every patient because they are potentially correctable and their identification may spare the patient a lifetime of blood pressure medications. However, the diagnosis of secondary hypertension requires laboratory tests and procedures that are done only when some aspect of the history or physical examination raises a red flag in the mind of the doctor. Your doctor was undoubtedly concerned.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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