You're under 35 and feel fine, yet the doctor says your blood pressure is high and you'd better come back to have it checked again. Being a red-blooded male, you figure five years will be soon enough. After all, isn't high blood pressure an old man's disease?
"Young men are less likely than older men to believe they have hypertension and less likely to go back to the doctor," says Daniel Lackland, DrPH, spokesman for the American Society of Hypertension. "Often these are patients whose blood pressure would respond to weight management and other lifestyle changes, but they're less likely to seek treatment."
Untreated hypertension damages the heart and other organs and can lead to life-threatening conditions that include heart disease, stroke, and kidney disease. It's called "the silent killer" because symptoms generally appear only after the disease has caused damage to vital organs.
"With treatment, we can truly prolong life," Lackland tells WebMD.
Understanding High Blood Pressure
If your blood pressure is 120/80, 120 represents systolic pressure, or the pressure of blood against artery walls when the heart beats. Eighty represents diastolic pressure, or the pressure between beats.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines categorize hypertension as follows:
- Normal. Less than 120/80
- Elevated. 120-129/ below 80
- Hypertension. 130/80
- Stage 2 hypertension. 140/90
Hypertension, or high blood pressure (HBP), exists when either the systolic measurement is 130 or higher or the diastolic measurement is 80 or higher. However, in the majority of people, controlling systolic hypertension is a more important heart disease risk factor than diastolic blood pressure (except in young people under the age of 50).
There are two types of hypertension: essential, which accounts for 90% to 95% of cases, and secondary. The cause of essential hypertension is unknown, although lifestyle factors such as obesity, sedentary lifestyle, and excessive alcohol or salt intake contribute to the condition. In secondary hypertension, the cause may be kidney disease; hormonal imbalance; or drugs, including cocaine or alcohol.
According to the JNC 7, half the adult population is prehypertensive or hypertensive, and because blood pressure increases with age, most people will become hypertensive if they live long enough.
Younger vs. Older Men With High Blood Pressure
Younger men with high blood pressure typically have high diastolic pressure while older men have high systolic pressure. "In young men, the diastolic pressure rises because the heart is pumping harder," says Lackland. "In older men, the systolic pressure rises and stiffens arteries.
"Part of the problem with young men is increased body mass. Ten years ago we wouldn't have seen hypertension in the teens and 20s, but now it's increasing along with rising obesity rates. We're seeing the increase in particular in African-American men, but it affects men of all races."
Lackland, who is professor of epidemiology and medicine at the Medical University of South Carolina in Charleston, says that as with older men, treatment for younger men follows JNC 7 guidelines for lifestyle changes and medications.
The JNC 7 recommends the following lifestyle modifications for people with prehypertension as well as hypertension:
Weight reduction. Maintain a normal weight with a target body mass index (BMI) of 18.5 to 24.9.
This can result in an approximate reduction in systolic blood pressure of 5-20 points per 10 kilograms of weight loss, according to the JNC 7.
DASH (Dietary Approaches to Stop Hypertension) eating plan. Adopt a diet rich in fruits, vegetables, and low-fat dairy products. Reduce saturated and total fat. This can be expected to drop systolic blood pressure by 8-14 points.
Lower salt intake. Reduce dietary sodium to less than 2,400 milligrams or about 1 teaspoon a day. According to the JNC 7, a 1,600-milligram sodium DASH eating plan has effects similar to a single drug therapy. The approximate reduction in systolic blood pressure would be 2-8 points.
Moderation of alcohol consumption. Men should limit alcohol to no more than two drinks per day. A standard drink is defined by the type of alcohol. For example, a standard drink, such as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5-ounce shot of 80-proof distilled spirits, has between 11 and 14 grams of alcohol. Limiting the amount of alcohol to this quantity is expected to result in a reduction in systolic blood pressure by 2-4 points.
When medications are indicated for younger men, one question is what will be the long-term effect? "We've had medications around since the 1970s, but with newer ARBs (angiotensin receptor blockers), we don't know," says Lackland. "But the benefit of keeping blood pressure to goal is so great. Without treatment, a man at [age] 30 could be facing end-stage renal disease, stroke, or heart attack."
Another Complication Worth Considering
If the threat of premature death from complications of untreated high blood pressure doesn't get your attention, perhaps this will: A recent study showed that men with high blood pressure were 2.5 times as likely as men with normal pressure to develop erectile dysfunction (ED). Men with prehypertension also had a higher incidence of ED than did men with normal pressure.
Michael Doumas, MD, of the University of Athens in Greece, presented the study at the American Society of Hypertension 20th Annual Scientific Meeting and Exposition. In order to assess the link between hypertension and erectile dysfunction, researchers excluded men who had a history of diabetes, heart disease, renal failure, or liver and vascular disease, which are associated with ED.
While the study of men aged 31 to 65 didn't compare younger vs. older men, the fact that more than one-third of the participants with high blood pressure had erectile dysfunction should be seen as another very good reason to seek treatment and follow doctor's orders.
Young men with hypertension often have what's called "metabolic syndrome," which is known to contribute to heart disease and diabetes. It includes a cluster of risk factors found in an individual and include excess body fat (especially around the waist and chest), high cholesterol, and insulin resistance. Studies have also shown that early vertex baldness can be associated with HBP. In addition, obstructive sleep apnea and snoring are linked to HBP in men in general.
Family history plays a role, but whether its importance varies with age of onset is unknown. "From epidemiological and twin studies, estimates range from 10% to 40%," says Ulrich Broeckel, MD, who is researching the role of genetics in hypertension. The goal of research is to subcategorize hypertension in order to improve diagnosis and treatment. "We're not ready for a diagnostic test, but ultimately we'll treat patients better based on their genetic makeup."
Learn to Manage Anger
Managing anger may be more important for younger men than older men, says Charles Spielberger, PhD, professor of psychology at the University of South Florida in Tampa. "I don't know of studies that look only at men under age 35, but a young man is dealing with a lifelong habit of anger," he tells WebMD.
He says anger involves feelings ranging from annoyance to rage and causes psychological and biological changes. Spielberger developed the widely used STAXI (State Trait Anger Expression Inventory) to assess anger and has studied the role of anger in hypertension. "Research shows it is people who are boiling inside but don't show it who are more likely to develop hypertension."
Anger can also be a personality trait. "Some people feel anger more often across a wider variety of situations. People who do this and hold it in, they're the ones in danger of hypertension."
Spielberger tells WebMD that a good anger management program can help someone lower or normalize blood pressure. It's a three-step process.
First, learn to recognize the anger and the situations that cause it. "A lot of people who feel anger frequently might not recognize it, especially low to moderate levels."
Second, analyze the situation. "If your supervisor frequently makes you and other employees angry, tell yourself 'It's not me. This person is supercritical. I'll listen to what he says, but I'm not going to blame myself for his bad disposition.'"
Third, reduce the anger. "Counting to 10 will distract you, or try muscle relaxation. If possible, avoid the situation."
What About 'White Coat Hypertension?'
If you have a physical exam that shows elevated blood pressure, your doctor might say it could be "white coat hypertension," meaning the stress of seeing the doctor caused the high reading.
White coat hypertension was once thought to be benign, but that may not be the case, says Ulrich Broeckel, who is assistant professor of medicine at the Medical College of Wisconsin in Milwaukee. He co-authored a study of 1,677 patients aged 25 to 74. The study, reported in the British Medical Journal, measured structural changes in the heart, which Broeckel says were probably related to stress and the response to stress. "We found a significant difference between people who had white coat hypertension and those who didn't. It suggests that if people have these increases in blood pressure when they see a doctor, they have them in other stressful situations," says Broeckel.
Don't Wait 5 Years
"The longer you have untreated hypertension, the more complications you get," says Broeckel. "We also know patients who had early onset hypertension and developed diabetes at an early age. It makes early diagnosis and treatment very important."