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So, I just had a 23 year old white male presenting with a chief complaint of headache since last night. He told the front desk that he is just here for the doctor’s note for work. Today, of course, is New Year’s Day, which is the national holiday for doctor’s notes.

headacheHe said that he’s had headaches on and off for the past couple of months, which respond well to Tylenol. The patient appeared well on exam. He had no fever, neck stiffness, intolerance of light, rash. He denied any other symptoms. He denied any past medical history. The exam was unremarkable. His vitals signs were temp 98.1, pulse 72, oxygen 100% on room air, BP 158/100, weight 280#, height 5’8″.

Based on the above, would you ask anything, or else just give him his doctor’s note and scoot him on his way?



What I asked was, “Have you ever been told your blood pressure is high before?”

As noted before in these pages, vital signs are vital. That’s why we take them with every single patient, even a seemingly-obvious post-NYE hungover headache patient just wanting to call out of work. And that BP is anything but normal.

It turned out that he had visited other urgent cares twice over the past two months, and each time he had been sent to the ER. And each time, the ER gave him no medication for his blood pressure, owing mainly to his youth, telling him to lose weight instead. It also turned out that he has a strong family history of high blood pressure on both sides of his family.

Now, it is true that hypertension is viewed as a disease of older people. Even by doctors, such as the ER doctors that he saw. But so is type 2 diabetes, and as Rob Kardashian could tell you, that disease has no qualms striking 20-somethings. Especially those who are heavy-set. Same thing with high blood pressure.

Even if high blood pressure has no symptoms, we treat it. Uncontrolled, it can lead to heart damage, strokes, kidney damage, eye damage. And in my opinion, hypertension that strikes at a young age is even more important to treat. Think of it this way: by occurring at age 23, it has 20 extra years to wreck havoc compared to your typical 40-something HTN patient.

And on top of that, my patient was symptomatic. Yeah sure, in theory he could control his pressure by lowering his weight to a normal range. But even if he did (and, let’s face it, the odds are not in his favor), that would take months if not years. That’s a long time to walk around with headaches caused by blood pressure so high, it causes urgent care doctors to send you to the ER.

So I treated him with a daily medication. I advised him that he needs to monitor his blood pressure with his home autocuff (and the fact that he already has such a device was also a red flag). If his pressures continue to be high, he needs to come back to up the dose or add different medications.

Hypertension may not be as dreadful or as dramatic as some of the conditions touched on in this series, but that doesn’t stop it from being a killer. According to the CDC, almost a third of the population suffers from high blood pressure, directly accounting for 30k deaths per year. And that’s not including strokes and heart attacks that the disease contributes to. Please check your blood pressure at least once a year no matter who you are, or more often if you are older, heavier or if family members are being treated for high blood pressure.