What causes hypertension in a young person?

Causes of Hypertension in Young People

The primary causes of hypertension in young people include obesity, kidney disease, genetic factors, and various lifestyle factors, with obesity being the most significant modifiable risk factor. 1, 2

Primary Causes

Renal and Cardiovascular Causes

• Renal parenchymal disease and structural kidney abnormalities account for 34-79% of secondary hypertension cases in children and young people 2
• Renovascular disease is present in 12-13% of secondary hypertension cases in youth 2
• Coarctation of aorta is a significant cause particularly in children and young adolescents 2
• Chronic kidney disease (CKD) is associated with hypertension in approximately 50% of affected children 1

Endocrine Causes

• Primary hyperaldosteronism is more common in young adults with resistant hypertension 2
• Pheochromocytoma, though rare, should be considered in young patients with severe or paroxysmal hypertension 2

Obesity and Metabolic Factors

• Childhood obesity is strongly linked to the development of hypertension, with a fourfold increase in blood pressure among those with severe obesity (BMI >99th percentile) versus a twofold increase in those with obesity (BMI 95th-98th percentiles) 1
• The risk of hypertension increases with obesity severity and duration 1
• Elevated BMI as early as infancy is associated with higher future blood pressure 1
• Obesity may be responsible for approximately 40-78% of hypertension cases 1

Genetic and Familial Factors

• Hypertension is a complex polygenic disorder with multiple genes influencing blood pressure 1
• While monogenic forms of hypertension exist (glucocorticoid-remediable aldosteronism, Liddle's syndrome, Gordon's syndrome), these are rare 1
• The presence of multiple small-effect genetic variants associated with higher blood pressure results in more rapid blood pressure increases with age 1
• Family history of hypertension is a significant risk factor for developing hypertension in youth 3

Environmental and Lifestyle Factors

• Poor diet, particularly high sodium intake and insufficient potassium, calcium, and magnesium intake 1, 2
• Physical inactivity is strongly associated with higher blood pressure in youth 1, 3
• Tobacco exposure increases risk of developing hypertension 1
• Sleep disorders, particularly obstructive sleep apnea, are present in 25-50% of patients with resistant hypertension 2
• Environmental toxins such as lead and cadmium exposure are associated with higher blood pressure 2
• Chronic stress and psychosocial factors may contribute to hypertension development 4, 5

Medication and Substance-Related Causes

• Certain medications can increase blood pressure, including:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 1, 2
  • Decongestants 1
  • Oral contraceptives 1
  • Stimulants 1
• Alcohol consumption 1, 2
• Caffeine and energy drinks 1, 2
• Illicit drugs, especially cocaine 1

Diagnostic Considerations

• In young patients with severe hypertension and minimal family history, secondary causes should be strongly considered 2
• Evaluation should include assessment for target organ damage, particularly left ventricular hypertrophy 2
• Basic laboratory testing should include renal function, electrolytes, and urinalysis 2
• Blood pressure classification in children and adolescents is based on percentiles according to age, sex, and height 1
• For children aged 1-13 years, normal BP is <90th percentile; for those ≥13 years, normal BP is <120/<80 mm Hg 1

Clinical Implications

• Young patients with hypertension are at increased risk for accelerated vascular aging 1
• Both autopsy and imaging studies have demonstrated blood pressure-related cardiovascular damage in youth 1
• Early detection and treatment of hypertension in young people is crucial to prevent long-term cardiovascular complications 1, 3
• Becoming normal weight after being obese reduces the risk of developing hypertension to a level similar to those who had never been obese 1

Prevention and Management

• Lifestyle modifications are the cornerstone of prevention and initial treatment, including:
  • Weight management and achieving normal BMI 1, 6
  • Regular physical activity 1, 6
  • DASH-type diet with reduced sodium intake 6
  • Avoiding tobacco, excessive alcohol, and stimulants 1
• Pharmacologic treatment should be considered for persistent hypertension despite lifestyle changes, secondary hypertension, or evidence of target organ damage 2