High blood pressure in young people is not always caused by stress, excess salt or an unhealthy lifestyle. While obesity, physical inactivity, family history, excessive salt intake, poor sleep and other lifestyle factors commonly contribute to hypertension, some patients have an identifiable underlying medical condition. This is called secondary hypertension. Disorders involving the kidneys, adrenal glands, thyroid gland, blood vessels or certain inherited conditions may cause blood pressure to rise. One important hormonal cause is primary aldosteronism, in which the adrenal glands produce excessive aldosterone, causing sodium retention, increased blood pressure and sometimes low potassium levels. Importantly, many patients with primary aldosteronism have normal potassium levels, so the condition can be missed if testing depends only on detecting low potassium.

Several endocrine disorders can cause high blood pressure, and identifying them may significantly change treatment. Pheochromocytoma, a rare catecholamine-producing tumour usually arising from the adrenal gland, may cause episodes of severe hypertension associated with headaches, sweating and palpitations. Cushing syndrome, caused by excessive cortisol, can lead to hypertension along with weight gain, muscle weakness and other characteristic changes. Thyroid disorders, certain parathyroid conditions and rare inherited hormonal disorders may also contribute. Kidney disease, narrowing of the arteries supplying the kidneys, obstructive sleep apnea and some medicines can be important causes. In selected patients, diagnosing and treating the underlying disorder may substantially improve blood pressure control and sometimes reduce or eliminate the need for long-term blood pressure medicines.

Not every young person with high blood pressure requires extensive hormonal testing, but unexplained or difficult-to-control hypertension deserves careful evaluation. Blood pressure should first be measured correctly and, when appropriate, confirmed using home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring (ABPM). These methods help identify persistent hypertension, white-coat hypertension and masked hypertension. A detailed assessment includes age at onset, family history, medicines, lifestyle, kidney health and associated symptoms. Selected investigations may include kidney function, sodium and potassium, urine testing, thyroid function, and plasma aldosterone and renin measurements. Tests for cortisol excess, pheochromocytoma or renovascular disease are considered when clinical findings suggest these conditions. The choice and interpretation of hormonal tests require care because several blood pressure medicines can affect their results.

Early diagnosis can help protect the heart, kidneys, brain and blood vessels for years to come. Treatment depends on the underlying cause, severity of blood pressure elevation and overall cardiovascular risk. It may involve weight management, reduced salt intake, regular physical activity, improved sleep and appropriate blood pressure medicines. When an endocrine cause is identified, specific hormonal treatment or occasionally surgery may offer better control than routine blood pressure medicines alone. Dr. Rajesh Moganti (MD, DM Endocrinology) provides comprehensive evaluation and management of young-onset hypertension, resistant hypertension, primary aldosteronism, adrenal-related hypertension and other endocrine causes of high blood pressure at our Rajahmundry and Tanuku centres. The focus is on identifying treatable underlying causes, avoiding unnecessary investigations and developing a personalised long-term management plan.