Hypertension in the young is essentially primary hypertension and is on the rise because of rapid urbanization, increasing stress, addiction to tobacco and alcohol, and changing lifestyles. However secondary hypertension also needs to be rued out as it is remediable. Life-long treatment can be avoided if the cause of hypertension is detected. Hypertension if not controlled can increase the risk of paralysis or heart attacks or kidney failure. Early detection of blood pressure in young adults and their appropriate treatment Is necessary.
Who are young adults?
The definition of young adults is not clear. However, hypertension between 20 and 49 years may be taken as in Framingham Offspring Study. There is a continuous relationship between the level of blood pressure and the risk of complications starting at a BP of 110/75. The incidence of complications due to high blood pressure is higher in Asians and particularly Indians. The diagnosis of hypertension is based on at least two or more blood pressure readings taken on two different occasions.
When should BP be checked in young adults?
All individuals of 18 years and above should have their office BP measured at every point of contact with health professionals or allied health staff. Whatever may be the reason to visit a doctor, nurse, or paramedic, blood pressure measurement should be encouraged. This screening will enable people with high normal 13P to be identified. This will prevent them from getting hypertension by following appropriate lifestyle changes.
What are the risk factors for hypertension in young adults Excess salt, lack of physical activity, and stressful conditions are the coin-mon causes?
Besides this excess sugar, smoking, tobacco, improper sleep and a sedentary lifestyles are important contributing factors & Lack of exposure to proper sunlight is common in today’s tech-savvy young adults. Consumption of saturated fats and prolonged sitting completes the whole picture. Risk factors like physical inactivity, weight gain, obesity, metabolic syndrome, and obstructive sleep apnoea contribute further. A high sodium diet, low potassium, and calcium-urn further contribute to high blood pressure. What are the causes of hypertension in young adults? Most of them have no identifiable cause. If blood pressure is very high on the first presentation, episodic rise in blood pressure, nonresponding blood pressure, or poorly responding blood pressure in spite of good adherence consider secondary causes for hypertension. In those with resistant hypertension, secondary causes need to be considered.
What are the common causes of secondary hypertension in young adults?
Special inquiry about illicit drug use, oral contraceptive pills, and other medications should be made in this group of patients. Pain killers, steroids, some antidepressants drugs, cocaine, herbal drugs consumption should be enquired. Blood supply to kidneys, kidney function tests, certain endocrine disorders should be assessed. Investigations for pheochromocytoma, renal artery stenosis, and hyper-aldosteronism should be required in certain cases.
What is management?
Young hypertensive patients respond well to nonpharmacological treatment. Regular physical activity, weight loss, avoidance of tobacco, excess alcohol, and stress management are important components of such therapy. Daily brisk walking for 30 minutes and outdoor games have proven to reduce blood pressure. If blood pressure is in the high normal range or hypertension range then he is advised to follow the Dietary Approaches to Stop Hypertension. This is also known as the DASH diet. This diet is rich in fruits, vegetables and low in dairy products. There is reduced content of saturated and total fats. The total intake of salt is reduced to less than 6 grams per day Avoidance of fast food, excess tea, coffee, aerated drinks are key components of the diet. Adequate sleep, yoga, and meditation have been found to be useful. Young adults should spend some quality time in these activities.
What about pharmacological treatment?
Young adults basically do not take treatment or their adherence to treatment is very poor. This is because high blood pressure may not be associated with symptoms at all times. The treatment needs to be targeted to have a blood pressure of 120/80 in young adults. This can be achieved by lifestyle changes and medications. The choice of medications will be decided by a proper discussion between the patient and doctor. The probable effects and side effects should be properly discussed.
What about the comprehensive approach?
Many young adults may have associated comorbid conditions like obesity, diabetes or prediabetes, sleep apnea, anxiety and depression, high cholesterol, and addiction to certain drugs or nicotine. All these aspects are considered by your treating doctor before your treatment is planned.
Youth and technology?
There are gadgets and mobile applications available to manage hypertension. They can monitor your exercises, calorie expenditure your diet as well. The young hypertensive population being technologically savvy, should utilize all these applications. However, their limitations should not be overlooked. Hypertension in the young should be carefully evaluated and treated, as this is a significant cause for mortality and morbidity. It is certainly difficult to convince a young patient about the need to control his blood pressure. Lifestyle changes, low salt consumption, and regular treatment and follow-up are suggested.
