From the Guidelines
For a young person under 30 with high blood pressure, the initial evaluation should include a comprehensive assessment to identify potential underlying causes, with a focus on secondary hypertension, which is more common in this age group than primary hypertension. The evaluation should start with a thorough medical history, physical examination, and laboratory tests, including:
- Comprehensive blood tests to check kidney function, electrolytes, glucose levels, and lipid profile 1
- Urinalysis to detect protein or blood that might indicate kidney disease
- A 24-hour ambulatory blood pressure monitoring to provide more accurate readings than single office measurements 1
- An electrocardiogram (ECG) to assess heart function and look for signs of heart strain Additional tests may include:
- Thyroid function tests, as thyroid disorders can cause hypertension
- Tests for hormonal conditions like Cushing's syndrome or pheochromocytoma
- Renal ultrasound or CT scan to check for kidney abnormalities or adrenal tumors These tests are particularly important in young patients because high blood pressure at this age is often secondary to an underlying condition rather than essential hypertension, which is more common in older adults. Early identification of the cause allows for targeted treatment and potentially prevents long-term complications like heart disease, stroke, and kidney damage. It is also essential to follow the guidelines for screening and management of high blood pressure in children and adolescents, as outlined in the clinical practice guideline for screening and management of high blood pressure in children and adolescents 1.
From the Research
Investigating High Blood Pressure Under 30
- High blood pressure, or hypertension, is a significant health concern that affects a substantial portion of the adult population worldwide 2.
- Lifestyle interventions, including regular physical exercise, body weight management, and healthy dietary patterns, have been shown to be effective in preventing and treating hypertension 2, 3, 4, 5.
- Additional lifestyle modifications, such as stress management, adequate sleep patterns, and moderation of alcohol consumption, may also be beneficial in reducing blood pressure 2, 3, 5.
Lifestyle Interventions for Hypertension
- Regular physical activity has been found to have extensive benefits in improving blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 4.
- A healthy dietary pattern, such as the Dietary Approaches to Stop Hypertension (DASH) eating plan, can help reduce blood pressure 5.
- Weight loss or maintenance of a healthy body weight, as well as restriction of sodium intake, can also be effective in reducing blood pressure 3, 5.
Management of Hypertension
- For patients with mildly or moderately elevated blood pressure, lifestyle-only approaches are often recommended as the first line of therapy 4.
- Pharmacists can play a crucial role in managing hypertension by educating patients on lifestyle modifications and managing their medications 5.
- In some cases, antihypertensive medications may be necessary, and combination therapy with an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic may be effective in achieving blood pressure control 6.