Thank you for your query at doctorspring.com
I agree with you that finding a cause in a young hypertensive can be frustrating for both the doctors and the patient.
But thankfully there is a set process for evaluation. There are two kinds of hypertension.
1. Essential (most common). The hypertension is the disease . No other cause.
2. Secondary (due to other causes / diseases)
So I understand that you have been well evaluated for a secondary causes and all tests turned out to be negative. (MRI study of the renal vessels / doppler / urine tests / hormonal assays / electrolytes are the major tests). So I would this is actually a good news. You have no identifiable cause and most likely this is essential hypertension. You should be glad as few medication and lifestyle measure can control this blood pressure. Contrary to popular belief Essential hypertension can occur in young age. And you should know that in over 95% of individuals there is no cause indefinable for hypertension.
What you should do now is :
1. Get in touch with your Doctor make sure all the causes of secondary hypertension has been ruled out.
2. Take adequate medications. Stay fit. Cut down on salt, keep bp below 130/90mmg Hg.
**The fact that you are a premature underweight born child makes you more prone to development of hypertension because a premature under weight child has less of nephron in his kidney and this leads to pressure on kidney for salt excretion and leads to salt sensitivity and fluid and salt retention and finally hypertension.
As for bp control during your pregnancy blood pressure needs to be controlled adequately during pregnancy so as to avoid adverse outcomes for you and your baby. Your OBGYN will take care of this. This is no big deal and you can have a very safe pregnancy.
Dr Vivek Mahajan
Patient replied :
Thank you for your reply. I have always wondered if my prematurity was the underlying cause of developing hypertension so young.
My next question to you is in regard to the vascular insufficiency in my lower extremities. I cannot stand for more than 10 minutes without my legs becoming red, very hot, and moderately swollen. This condition has gradually become worse over the last few years and is very noticeable to others now. I do not have varicose veins and the pulses in my feet usually satisfactory enough to those doctors who have checked. Your opinion on this would be greatly appreciated.
Was a doppler study (ultrasound like test) done for the lower limbs ?
Patient replied :
No, I have not had that done before.
In that case it is not possible to say for sure that vascular insufficient is the cause. Some individuals have an increased vascular permeability (capillary permeability) rather than pure vascular insufficiency.
Either way if the symptoms are troublesome a baseline evaluation may be done. This should include a Doppler study of the lower limbs, urine protein, renal function tests, ANA.
Most of these tests might have been done already. And these are not necessary. So please discuss this with your Doctor before proceeding further.
Hope this help