What are some of the causes of elevated systolic blood pressure in an otherwise young, healthy and asymptomatic patient?
Probably some of the more common causes would be poor diet and lack exercise. Not everyone who eats poorly and doesn't exercise will be over weight since genetics plays a role. That is, a young adult can appear to be healthy but be internally suffering. Another question would be is this otherwise health individual a smoker?
Two recent studies confirm the blood pressure benefits of maintaining a healthy diet. First is the Dietary Approaches to Stop Hypertension (DASH) clinical study, which tested the effects of food nutrients on blood pressure. It emphasizes consumption of fruits, vegetables, and lowfat dairy foods, whole grains, poultry, fish, and nuts, and stresses reduction of fats, red meats, sweets, and sugared beverages.
Second is the DASH-sodium study, which demonstrates the importance of lowering sodium (salt) intake. Most Americans consume far more than the current, daily recommendation of 2,400 milligrams (mg) of sodium—about a teaspoon of table salt—or less. This includes all salt and sodium consumed, not just at the table, but also in cooking. For those with high blood pressure, consuming even less may be advisable, since the DASH-sodium study revealed that diets containing no more than 1,500 mg of sodium per day had still greater pressure-lowering effects.
Regular physical activity is another good step toward controlling or even preventing high blood pressure. Start with 30 minutes of moderate-level activity, such as brisk walking, bicycling or gardening on most—preferably all—days of the week. The activity even may be divided into three, 10-minute periods each. For added benefit, these moderate half-hours may be increased or supplanted by regular, vigorous exercise. Of course, prior to upping the activity level, people should check with their physicians, especially if they have had heart trouble or a previous heart attack, a family history of heart disease at an early age, or other serious health problems.
Another healthy move is to limit alcohol intake. Excess alcohol can raise blood pressure as well as damage the liver, heart, and brain. Drinks should be kept to a maximum of one per day for women, and two for men. (One drink equals 12 ounces of beer or five ounces of wine.)
Finally, quit smoking. Among other things, smoking damages blood vessel walls and speeds hardening of the arteries. Ceasing smoking reduces the risk of heart attack in just one year .
I would say this would probably be the most common causes of a young, health adult presenting with asymptomatic hypertension; however, there can be other reasons as well. For instance, another cause could be paraganglioma. The NIH presented a case of a 19 year old female with asymptomatic severe hypertension in 2010. The woman had a BP of 220/140 mmHg. Her lab results showed elevated plasma norepinephrine, 1807 pg/ml, and 24h urinary free catecholamines, 483 ug/24h. After resection of the tumor, the patients BP was normal during followup. You can read the entire article here which is rather interesting.
- Paraganglioma in a young patient with asymptomatic severe hypertension: a case report and review of the literature
Additionally reading on paraganalioma.
In most cases there is no definite cause, but here are factors which potentially can contribute to raised blood pressure:
- smoking or too much drinking alcohol,
- lack of physical activity,
- being overweight,
- having too much salt in your diet,
- not eating enough fruit and vegetables,
It can also relate to low levels of nitric oxide which plays a leading role in blood flow and it is an essential molecule involved in key functions in our body. It acts as vasodilator (dilates the blood vessels to allow blood to flow), so low levels could have considerable health implications. Enough levels improved blood flow and avoidance of dangerous cardiovascular conditions. As we age, the level of nitric oxide declines. By eliminating a nitric oxide deficiency, you can improve blood flow and balances blood pressure by helping arteries to expand and blood to flow more freely.
Nitrate-rich vegetables, in particular leafy greens, such as spinach and arugula, and beetroot, have been shown to increase cardioprotective levels of nitric oxide with a corresponding reduction in blood pressure in pre-hypertensive persons.wiki Monitoring nitric oxide status can be achieved by saliva testing.