Andrew J. Rosen wasn't surprised when he was diagnosed with high blood pressure at 39. Both his parents had taken medication for years, which had effectively controlled the condition that affects nearly half of all American adults.
April 23, 2022, 3:24 PMAndrew J. Rosen wasn't surprised when he was diagnosed with high blood pressure at 39. Both his parents had taken medication for years, which had effectively controlled the condition that affects nearly half of all American adults and frequently runs in families.
Sometimes, doctors told him, the condition, also known as primary hypertension, can be difficult to control. Poorly controlled high blood pressure increases the risk of heart disease, stroke, irreversible kidney damage and early death. In fact, Rosen didn't know if that was true; he assiduously avoided taking his blood pressure at home. "It was anxiety-producing," he said. "It was always high." He hated feeling the cuff squeezing his arm and preferred to assume he did not have high blood pressure.
In 2011, after Rosen moved to the San Diego area, his new primary care doctor changed his blood pressure medications. When that resulted in only a minimal reduction, the doctor added two more drugs.But the elevated readings persisted. "It would be 148/90 when the nurse measured it on the machine several times," Rosen said. At the end of a visit, Rosen's doctor would do a quick manual reading and announce that it had dropped to 118/69.
The heart specialist ordered a stress echocardiogram, a test that measures how well the heart is functioning. It showed that Rosen's heart appeared to be normal, but the cardiologist was alarmed by his blood pressure, which was sometimes as high as 179/85, and increased the amount of the one drug Rosen wasn't taking at the maximum dose. He suggested that Rosen's hypertension might be the result of a kidney problem, but a kidney scan found nothing.
The disease can be detected by blood tests that measure the levels of aldosterone and renin, an enzyme made in the kidneys that helps control blood pressure, then calculating the ratio between the two. Further testing is required to confirm the diagnosis and to determine whether one or both adrenal glands are affected. In the latter case, PA is treated with medication. But in 30% of cases, PA is caused by a benign tumor on one gland. Surgically removing that gland can normalize blood pressure.
Soon afterward, Rosen saw a second endocrinologist, who agreed that PA seemed likely. She ordered additional testing along with a CT scan, which provided confirmation. The final step was a technically tricky procedure known as adrenal venous sampling, which involves the insertion of a catheter into the adrenal veins to determine whether one or both are affected. That finding would guide treatment.
Although doctors have long been taught that the disease is rare, Young said that recent studies show it is not. Researchers estimate that 5% to 10% of people with high blood pressure and 20% of those with resistant hypertension have PA. Most don't know it because they have never been tested.
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