Issue: 2015 > October > photo quiz

Hypertension at a young age: beware of the unexpected

D.J.L. van Twist, A.W.J.H. Dielis, A.A. Kroon
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A 25-year-old man with a clear medical record was referred because of accidentally discovered hypertension. He had a normal lifestyle and body mass index (20.4 kg/m2 ) and was not using any medication or other substances. A thorough physical examination was normal, except for high blood pressure (220/95 mmHg). Although 24-hour ambulatory blood pressure measurements showed a white coat effect, his blood pressure was nevertheless elevated: 151/101 mmHg. Routine laboratory tests, including serum potassium level, were normal and the estimated glomerular filtration rate was 85 ml/ min/1.73m2. As echocardiography revealed left ventricular hypertrophy, treatment with valsartan 80 mg daily was initiated, resulting in a decrease in the blood pressure to 130/75 mmHg. Given his young age and the presence of left ventricular hypertrophy, we suspected renovascular hypertension (e.g. due to fibromuscular dysplasia) and performed an invasive renal digital subtraction angiography (figure 1).