Doctor’s Tip: High blood pressure, an unfortunate story
The column two weeks ago was about medications for hypertension (high blood pressure). The Post Independent posts these health columns on the internet, and that particular column generated several emails from around the country, and one from Africa — people wanting help managing their BP, which of course I told them I couldn’t do from afar, other than recommending regular exercise and plant-based, low sodium nutrition. One email was from a 57-year-old man in California, A.R., who agreed to let me share his story in this column.
A.R. has family members with hypertension, successfully treated with medication. He was diagnosed with hypertension himself in his early 40s. His primary care physician gradually added medications over several years. Eventually, A.R. ended up on five blood pressure pills, but his BP remained elevated.
He suggested to his primary care physician that he might have secondary hypertension (caused by something other than the usual “essential hypertension,” that tends to run in families). His PCP dismissed this possibility, and eventually A.R. self-referred to an endocrinologist, who after some simple testing diagnosed one of the more common causes of secondary hypertension: primary hyperaldosteronism, where — usually as the result of a small, benign tumor — the adrenal gland secretes too much of the hormone aldosterone, which at high levels causes blood pressure elevation.
A.R. went to the Mayo Clinic, where the diagnosis was confirmed. He learned during the Mayo Clinic visit that in 5-10% of people with hypertension — and in 20% of people with resistant hypertension — the cause is primary hyperaldosteronism, a condition that is underdiagnosed. Testing showed that A.R.’s hyperaldosteronism was related to a small tumor on his left adrenal gland. This was fixed by laparoscopic removal of the left adrenal (you can get by fine with just one adrenal gland). Five weeks later, A.R.’s blood pressure was normal on just one medication, and he likely will be able to discontinue that.
Hypertension from hyperaldosteronism causes even more damage to arteries than other hypertension, and some authorities feel that all people with hypertension should be checked for hyperaldosteronism. A.R. is rightly concerned that damage to his blood vessels and kidneys occurred during all those years of delayed diagnosis and treatment. Treatment for hyperaldosteronism doesn’t always involve surgery — specific medications can also be helpful in mild cases.
Without question, secondary hypertension should always be considered if a young person (less than 40 or so) presents with high blood pressure; if someone younger than 50 has a stroke; if BP is consistently greater than 150/100; if blood pressure control requires more than two medications; and if potassium is low on a chemistry panel. Causes of secondary hypertension other than primary aldosteronism, include: too much cortisone hormone due to an endocrine disorder or prescribed as medication; sleep apnea; drugs such as cocaine, alcohol, caffeine, decongestants, NSAIDs (e.g. ibuprofen and naproxen), certain antidepressants and some birth control pills; chronic kidney disease; narrowing of the renal (kidney) arteries from hardening of the arteries; and thyroid or parathyroid gland disorders.
If you have hypertension in spite of optimal lifestyle and more than two medications, request a workup for secondary hypertension, including primary hyperaldosteronism. If your provider dismisses your concerns, get a second opinion.
Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email firstname.lastname@example.org.
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