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HIgh BP. Advised TMT, echo for CAD and mitral valve prolapse. Is this justifiable?

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Cardiologist, Interventional
Practicing since : 1996
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My son aged 21 is having BP of 150/80. The doctor advised TMT and echo for CAD and MITRAL VALVE prolapse. He also advised olmezest 10 mg after breakfast. Is the apprehension of the doctor justifiable.
Posted Mon, 21 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 19 hours later
Thank you for your query.

At 21 years of age, it is not usual to have a systolic BP of 150 mmHg. The cause for this systolic hypertension needs to be evaluated.

But, before that, it would be nice to confirm that the BP is persistently high and that multiple abnormal readings are there over a period of time and that the high values are not due to undue anxiety or stress.

If the systolic BP is high on multiple readings, and confirmed with home measurement of BP or measurement at a time when there is no stress, then we need to look at all the causes of isolated systolic hypertension. The importance of this is that some of these causes can be corrected.

This would mean a detailed history and clinical evaluation to look for any evidence of secondary hypertension, and then investigations including renal function tests, thyroid function tests, serum potassium levels, urine protein excretion, ECG, echo, fundus examination and blood counts. Based on the values and results, further specific testing may be needed.

In the echo, it is not just mitral valve prolapse that is important, but also the presence of left ventricular hypertrophy, any other valvular problems, LV function, coarctation of aorta, etc all need to be considered.

A TMT is reasonable if there are strong risk factors for CAD like smoking, diabetes, abnormal lipids and a strong family history of heart disease, in addition to the high BP. TMT is also useful to know the change of BP with exercise. A hypertensive BP response during exercise may confirm that the mildly elevated resting systolic BP is indeed abnormal and that BP may further increase with age.

If there is confirmation of abnormally elevated BP and if there are no secondary causes and if there is no evidence of target organ damage, it is reasonable to try and control the BP initially by dietary measures like salt restriction, adequate intake of fruits and vegetables, reduction of starch in diet, reduction of red meat, etc and also to exercise for half an hour daily (walking, running, jogging, swimming). If the BP does not get controlled after a 3 month trial of diet and exercise, you could start medicines. Olmezest is a good drug to start in the young. Also, there are many who prefer to control the BP initially with drugs, bring it to normal levels and then try to maintain the BP with only diet and exercise.

I hope this answers your query. Feel free to ask me for any specific clarifications.
With regards,
Dr RS Varma
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