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High Blood Pressure

15 year old with hypertension

05/06/2008

Question:

My daughter (15 years old) is very active (on the track and swim team). 3 weeks ago her blood pressure was taken and it was high (190/125), it has stayed high. We were referred to a nephrologist who thought it was Fibro Muscular Displasia, he did a renal angogram which was negative. blood work was good. plasma renin activity test was a 5. a little bit of high cholesterol. Before all this blood pressure was 115/58 at a sport physical in October 07. Could this be just High blood pressure? grandparents have hypertension.

Answer:

A blood pressure of 190/125 is unusual in a 15 year old person.  It is important to repeat the measurement on several occasions to make sure that the high reading is not an isolated finding.  It may be helpful to do ambulatory 24 hour blood pressure monitoring to determine the extent of her hypertension.

If your daughter had a normal renal angiogram, then renal artery stenosis is ruled out.  However, there are other causes of severe hypertension in young people,  These will also have to be looked for:

- Hyperaldosteronism (by checking plasma renin and serum aldosterone levels)

- Pheochromocytoma (by checking 24 hour urine excretion of catecholamines and metanephrines)

- Cushing's syndrome (by checking a plasma cortisol level)

- Hyperthyroidism (by checking blood levels of thyroid hormone).

Familial causes of hypertension include Liddle's syndrome, Gordon's syndrome, as well as renal tumors.  These conditions are quite rare, however.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati