Hypertension in young people refers to high blood pressure found in individuals under 40 years of age.

 

Its causes may differ from hypertension in older adults. Some causes are treatable; if detected and managed early, long-term complications can be greatly reduced.

 

What are the causes of hypertension in young people?

1. Primary hypertension

Common in those aged over 18 years, especially people with risk factors such as:

• Obesity
• Family history of hypertension
• High-salt diet and physical inactivity

2. Secondary hypertension

Occurs more often in children and adolescents. Important causes include:

• Kidney diseases, e.g., glomerulonephritis, reflux nephropathy, polycystic kidney disease
• Endocrine disorders, e.g., hyperaldosteronism, adrenal tumors (pheochromocytoma), Cushing’s syndrome, hyperthyroidism
• Vascular disorders, e.g., renal artery stenosis, coarctation of the aorta, vasculitis
• Other causes include:
• Use of certain drugs or substances, e.g., NSAIDs, steroids, oral contraceptives, alcohol, illicit drugs
• Obstructive sleep apnea
• Stress

 

What are the symptoms in young people with hypertension?

Most patients are asymptomatic and are diagnosed incidentally during blood pressure measurement. Some may have:

• Headache, dizziness
• Frequent nosebleeds
• Fatigue, palpitations

 

How is hypertension in young people diagnosed?

1. History taking and physical examination

• Family history of hypertension or cardiovascular disease; history of drug use or substance abuse
• Symptoms suggesting secondary HT, e.g., headache, palpitations, sweating, muscle weakness, edema, abnormal urination
• Targeted examination to diagnose and seek causes, e.g., measuring blood pressure in both arms and both legs, weight measurement, listening for abdominal bruits along the flanks, thyroid examination, palpation of femoral pulses

2. Laboratory investigations

• Blood tests such as CBC, electrolytes, creatinine, fasting blood glucose, lipid profile, cortisol, thyroid function tests, aldosterone, renin, cortisol, metanephrines
• Urinalysis to detect red blood cells and proteinuria
• Electrocardiogram (ECG) and echocardiography
• Imaging, e.g., renal Doppler ultrasound, CTA/MRA of the renal arteries, abdominal CT/MRI

 

How is hypertension in young people treated?

1. Lifestyle modification

• Weight reduction if overweight or obese
• Regular exercise
• Reducing salt intake
• Avoiding alcohol and illicit substances

2. Pharmacologic therapy

Antihypertensive drug classes include:

• ACE inhibitors
• Angiotensin receptor blockers
• Calcium channel blockers
• Diuretics
• Beta-blockers

3. Treating the underlying cause in secondary HT, e.g., surgical removal of adrenal tumors, treatment of hyperthyroidism

 

What are the complications of hypertension in young people?

Without proper treatment, complications may include:

• Cardiomegaly, coronary artery disease, heart failure
• Chronic kidney disease
• Cerebrovascular disease (stroke)
• Retinopathy

 

Early diagnosis and treatment can significantly reduce long-term complications.