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How to manage essential hypertension in a young man?

Q: I am an unmarried male aged 25 and work in a senior position in a software organization at Chennai. I was diagnosed as having hypertension 3 years ago and have since started medication. I used to travel regularly abroad and within India and did not have a good food habit then. I took the routine kidney and other related scans to ascertain the cause of hypertension and was told that I had essential hypertension caused due to stress (only). I have taken a couple of similar scans and they did not show any abnormality. I applied for a LIC policy and underwent a full heart checkup last year (the LIC authorities were not satisfied with my regular ECG) which was normal. My mother is a diabetic and hypertensive as well. Currently I am being prescribed Lol 40 mg twice a day, Alprazolam 0.25 mg 1/2 tablet thrice a day, Covance 25 mg daily in the morning and Storvas 10 mg at night. Inspite of all these medicines, I still have a high BP. I measure it frequently at home using an Omron T8 BP machine and it consistenly hovers around 130/80-85 mm Hg mark. I also have anxiety related issues towards the end of the day in my office and tend to panic during these times and am not able to concentrate fully. I have been consulting the same doctor for the past 3 years. I can still undertake a monthly pilgrimage that includes a bare foot walk for 13 kms. I want to ask the following questions: 1. Do I have only hypertension or some associated side effects as well. If yes, how do I ascertain what is happening inside me. 2. Am I being over prescribed with these tablets and will they not become a habit during my later years? 3. What are the risks of my having a major disease related to heart or kidneys or any of my vital organs? One of my relatives (aged 35) was hypertensive and ended up having a kidney transplant last year. 4. Assuming that it is mind-related and not with my physical condition, what is the most effective way to come out of this position? 5. Will it be OK for me to marry or will there be any other associated complications?

A:The detailed summary of your medical report suggests that you have Essential Hypertension. I assume that all causes of secondary hypertension have been ruled out as it is important since your high BP seems to have started very early at 20 yrs only. This you must confirm with your physician/cardiologist. The target BP at all ages is around 120/80 mms Hg. I am not able to decipher what is LOL 40 mgs.BID. Losartan 25 mgs which you are taking is a very small dose. I do think you are on too many drugs. THe drug treatment of high BP is very long term and cholesterol lowering medicine is a very important accompaniment, again for long term. If the BP is kept at the target level, the complications in the long term are really minimised. Regular exercise, taking low salt diet, heart healthy low fat high fiber diet, keeping blood cholesterol and triglycerides less than 150 mgs/day, keeping body weight in the designated ideal limits, alcohol in moderation and having a good life style goes a long way in the management of this very common disorder.

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