Young Hypertension - Is It the Beginning of the End?

Abstract

Background: Hypertension is one of the leading causes of the global burden of cardiovascular diseases, stroke, renal failure and peripheral arterial disease (PAD). Young onset hypertension is on the rise due to various genetic and environmental factors like obesity, psychosocial stress, alcohol intake, sedentary lifestyle and a high salt diet. However, a huge fraction of the population remains undiagnosed or inadequately treated leading to cardiovascular complications. This case report shows the importance of identifying and treating young patients with hypertension even before the onset of subclinical target organ ischemic changes. Methods: A thirty-year-old previously healthy woman came with a three-month history of progressive vision loss in both eyes (left more than the right), fatigue, giddiness on prolonged standing, low-grade fever and loss of appetite. She was found to have feeble pulses in the upper limb with normal pulse and hypertension in the lower limbs. After appropriate imaging, she was diagnosed as a case of Takayasu arteritis type 2B presenting as anterior ischemic optic neuropathy. She was started on immunosuppression and antihypertensive. A thirty-six-year-old male, occasional smoker and alcoholic without comorbidities presented with one episode of seizures, oliguria and altered sensorium of 3 days duration. He was found to have malignant hypertension with end organ damage. Though initially thought of as secondary hypertension, he was found to have primary essential hypertension and his BP was controlled with appropriate medical therapy. Conclusions: Additional efforts should be made to screen young individuals for hypertension and adequate blood pressure control should be achieved at the earliest to avoid end-organ damage. Secondary causes of hypertension should be ruled out while evaluating a young hypertensive and appropriate therapy and lifestyle measures should be taken.