How can I help my daughter with her high blood pressure?  She has had it since age 12.

What could be the possible cause of high blood pressure in a child who was not overweight at the age of 12? Now an adult age, 21, (a little overweight now but she looks like she is carrying a lot of fluid) and still battling this high blood pressure. All of the medications that she has taken over the years have never worked, except one and she had to stop taking it because it caused facial swelling. My daughter’s daily numbers are between 179/104. The highest I saw recently was 210/141 and she was rushed to the hospital. The doctors never got it under control. Bottom numbers stays in the 100. She keeps a daily diary. All her medical tests always come back normal. High blood pressure does run in our family but it has always been controlled through medication. I am a very concerned mother. What steps should we take?

Submitted by Catherine from Maryland on 02/02/2016

Dear Mrs. Flowers,
The most common form of hypertension (high blood pressure) is hereditary. Efforts are directed towards keeping the pressure in an acceptable range and monitoring for signs of target organ damage (brain, kidney, heart). A good rule of thumb is to have 8/10 readings below 140/90. Further reductions are achieved by dietary changes and exercise. Lower targets may be desirable in specific patients. Those who do not respond or ‘break away’ from control need to be evaluated for uncommon causes of hypertension. A frequent diastolic reading above 100 is worrisome. Your daughter needs a thorough evaluation looking for uncommon causes of hypertension such as coarctation of the aorta, renovascular disease, pheochomocytoma, adrenal abnormalities, etc. Half of hypertensives are ‘salt sensitive’ and respond well to diuretics and salt (sodium) restriction with a target of <3000 mg a day. Weight loss is always beneficial and critical in some patients. I recommend that she be evaluated by a hypertension specialist (cardiologist or nephrologist). A physician that is new to her may provide a different insight into her condition. Sincerely.