Inherited High Blood Pressure In A Teenager

Essential (primary) hypertension, which is high blood pressure of unknown cause, generally develops in the middle years. The onset of hypertension in the teenage years or after the age of sixty, therefore, should raise a question about its underlying cause. Could the elevated blood pressure be secondary to kidney (renal) disease, a disruption in the blood circulation to the kidneys (renal artery blockage), or an adrenal gland hormone abnormality?

I recently saw a healthy appearing, athletic teenage boy in consultation. He had developed the recent onset of hypertension to as high as 180/110. The normal blood pressure in this age group is well under 140/90. Because of his young age, this patient had already had what was thought to be a complete medical workup to diagnose or exclude (rule out) the secondary causes of hypertension. He had also had a heart evaluation. In fact, an ultrasound exam of his heart (echocardiography) showed no enlargement yet from the hypertension.

A screening test using radioisotope imaging to detect a blockage of his renal arteries was normal (negative). This test is about 90% effective in ruling out a significant blockage that could stimulate the renin-angiotensin-aldosterone hormonal system to raise the blood pressure. Additionally, an excess of adrenalin was eliminated as a potential cause of the hypertension by the finding of normal urine hormone assays for catecholamines. The catecholamines are the metabolic products of adrenalin-related compounds.