High blood pressure (BP) is typically perceived to be a disease of the elderly. However, with rapid urbanisation and poor lifestyle choices, there has been an increase in the incidence of high blood pressure in the young population. It is emerging as an important contributor to chronic disease burden in India.
As per an Indian Council of Medical Research (ICMR) study in August 2019, one among four adults in India have high blood pressure. According to the fourth National Family Health Survey, high BP was reported in 13.8% men and 8.8% women aged 15-49 and 15-54 years respectively. District level household survey-4 reported that among the younger participants (18-25 years) hypertension was common with a prevalence of 12.1%.
Symptoms, risk factors
A young person experiencing recurrent headaches, vision changes, dizziness, nosebleeds, nausea and chest pain should get his/her BP checked, these could be indicators for hypertension. It is important to undergo regular health checkup, high BP is often silent and remains unrecognised unless checked.
As a result, a large number of people develop heart attack, stroke and kidney failure in their productive years of life. Lifestyle factors are critical determinants of BP levels operating against a background of genetic susceptibility. Excess body fat, poor dietary intake of vegetables and fruits, excess salt intake, tobacco use and lack of physical inactivity are some of the most important risk factors. Kidney disease, hormonal imbalance and drugs or alcohol can also cause high BP in the young population.
In about 10% of young adults, there are identifiable causes of high blood pressure. This is called secondary hypertension. In such cases, treating the identifiable cause leads to resolution of high blood pressure. Hence, it is essential to evaluate them for these secondary causes.
A 35-year-old man came in with resistant high BP in spite of being compliant with multiple BP medications. On further evaluation, he was found to have a condition called primary hyperaldosteronism. In this condition, the adrenal glands (located on top of the kidney) secrete a hormone called aldosterone excessively.
If a patient with a tumour producing the hormones (adrenal adenoma) is identified, surgical removal of the tumour will cure the high blood pressure. However, if not diagnosed correctly, it can lead to resistant hypertension and its long-term side effects, as routine BP medications may not help in this condition.
A 19-year-old college student had a severe case of high BP even after taking regular BP medication. Her Ultrasound Doppler evaluation revealed narrowing of the right kidney artery because of a condition called fibro-muscular dysplasia, a condition that causes narrowing and enlargement of medium-sized arteries.
Narrowed arteries may reduce blood flow and affect the function of the organs. This was treated by placing a stent in the narrowed kidney artery. Subsequently, she did not require any BP medication.
These examples show that hypertension in the young is common and often there may be correctable causes which might go undetected if not diagnosed.
An often unrecognised contributor to high blood pressure is obstructive sleep apnea. This is often seen in obese individuals, but also may be seen in non-obese individuals if they have upper airway obstruction. Treating OSA helps in controlling blood pressure.
There is often a lot of resistance among young hypertension patients to take medication.
It would prove beneficial for such individuals to educate themselves about the dangers of non-compliance with medications in terms of long-term consequences that are disabling and more difficult to treat.
Fortunately, we have a wide array of blood pressure medications to choose from, and most are safe or have reversible side effects.
(The writer is a Senior Consultant and Head of Interventional Cardiology at Sakra World Hospital)