I have a friend in renal failure. He’s 28 years old and just recently diagnosed. The underlying cause appears to be severe hypertension (200/90). His doctors have said that it is extremely rare to see someone his age with that kind of high blood pressure.
I’m curious about the hypertension but I don’t want to bother my friend with any questions, he’s very depressed right now (with good reason) and has a lot on his mind (again with good reason). The doctors are hoping that his kidneys will kick start themselves but if they don’t, it’s dialysis 12 hours a week until he gets a donor kidney.
He’s been under a lot of stress this year with personal problems, has been working two jobs that probably push him to 70 + hours a week and has a terrible diet (think Chinese take-out and Red Bull). He smokes but does not do drugs and drinks only moderately.
Is the hypertension a genetic luck of the draw? Or caused by the lousy year he’s been having? Or a combo of both?
It may be either primary (the cause of) or secondary (caused by) his crummy kidneys. It’s possible that external causes such as dietary and chemical indiscretions might be contributory but they are not the primary cause either of this type of elevated, sustained hypertension.
There may be extrarenal (non-kidney) causes of his crummy kidneys, as well. Presumably these have been looked for.
It’s genes in the broad sense; some specific secondary effect of his genetic makeup (perhaps with an environmental contribution) in the narrow sense.
In most cases of high blood pressure, a cause cannot be found. The answer is probably genetic. Various medicines are usually used to bring down blood pressure. Dialysis is not usually needed, but it can be in renal failure. I wish your friend well.
When you can find a cause for high blood pressure (only 5-10% of the time), it might be sleep apnea, a chemical problem like making too much aldosterone or catecholamines, kidney disease, thyroid problems, Cushing’s disease, heart problems (such as coarctation or aortic stensois), a brain tumour called pheochromocytoma, an adrenal tumour, narrow arteries to the kidney or related to drugs or diet.
Is your friend of African ancestry? Severe hypertension, with or without associated kidney problems, is more common in such individuals, even among people in their 20’s.
One theory for the relatively high frequency of hypertension among Western Hemisphere blacks has to do with the journey across the Atlantic when they (i.e. their ancestors) were abducted from Africa. Specifically, the conditions of the voyage were characterized by stifling heat, lack of drinking water, and diarrheal diseases. These are all things that would tend to cause severe lack of fluid in the body (i.e. dehydration). The people most likely to survive such circumstances may well have been those whose bodies were best able to hold onto salt and water.
Although the ability to hold on to salt and water would confer a survival advantage in the above circumstances, it’s actually a liability, leading to hypertension, under more normal conditions.
In any case, if true, this notion might explain the observation that hypertension is more common in north american blacks than in the caucasian population there, and even more common than in West African blacks (who’d be expected to share a similar genetic make-up). In other words, the survival advantage of avidly holding on to salt and water only manifests under condition of extreme water and salt deprivation (such as a cross Atlantic trip from hell). No such evolutionary pressure would have been exerted on Africans who were not kidnapped and taken across the ocean.
I’ve at least a dozen patients at present who have primary hypertension (they have it because that’s the way they’re put together, not as the result of another disease) and require at least 5 meds to keep their BP in acceptable ranges. One guy is on 6 meds.
And at least a third of my dialysis patients (18 at present) are on dialysis because of primary hypertension. Although one other had horrible hypertension from his kidney disease.
Are the guys who are taking 5 or 6 BP meds to get their BP in acceptable ranges at a higher risk for kidney failure? Or does the fact that their BPs are normal eliminate the risk?
The single most important thing to prevent the progression of kidney disease into frank kidney failure is blood pressure control. Despite all the talk, it doesn’t make any difference whether the BP is controlled with an ACE inhibitor or any other agent. The sole important fact is lowering of the BP.
Lowering BP, lowers the risk and rate of progression, but doesn’t eliminate it.
Well you’ll get arguments on both sides and plenty of anecdotal stuff. Generally with very high BPs such as the one in the OP, I don’t like to blame “stress,” whatever that is. Back in a different millenium (my first set of boards were Internal Medicine) I don’t think I had any patients who weren’t “stressed” whether or not they had hypertension. So my personal bias is not to blame stress, per se, esp with a systolic level of 200.
Even while admitting that some posters on this board might make my BP go up…
When I was younger I used to thrive on pressure, it seemed I was at my best when things were at their most chaotic, but as I got older I could actually feel a physical discomfort in stressful situations. I was diagnosed w/ HBP about 7-8 years ago, of course I’d also gained about 50-60 lbs. and had high cholesterol too.
This sounds like my brother’s best friend. In his particular case it was underlying kidney disease that was causing the high blood pressure and not the other way around.
This is obviously not a factual answer to anything but I thought I would say that P is also still waiting for a kidney (8 years later) but has the home dialysis set up and generally has a very good quality of life. Good job, dates lots, takes pictures of naked women on the side, etc. So while it’s not good news for your friend by any stretch, it certainly doesn’t mean his life is over.
I’ll end my touchy-feely-non-facutual spouting now. I wish your friend well.
It must. When I go to the doctor my blood pressure goes up. It’s called “White Coat Fever” This is pretty common and most doctors recognize it. It’s just temporary though. At home the BP is a lot lower.
See my post #9 in this thread as a follow-up, or if you don’t want to use me as a cite (big mistake :mad: … my BP rising…) start here: http://www.nyp.org/news/hospital/1023.html
This guy had a systolic of 200. If I were his physician I would try to address his stress but I would not blame his hypertension on it, per se.
Which is not to say we don’t see high-stress Type A’s w/ hypertension.
Possibly contributory depending on the individual. It’s helpful to have multiple BPs measured at different times of day, and I suppose, under differently-enabled stimuli.
