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If you’re diagnosed with high blood pressure you know the drill…
Your doctor tells you to exercise, lower your salt intake, lose weight and stop smoking if you’re a smoker.
Also, your doctor most likely prescribes medication designed to bring your blood pressure down.
But what if those steps aren’t enough to get your blood pressure under control?
In that case, you have what’s known as resistant hypertension. And it’s quite possible your doctor is overlooking the most common cause of secondary hypertension…
Blood pressure and your adrenal gland
The majority of high blood pressure cases are classified as primary or essential hypertension, meaning they don’t have an underlying cause. There are only two ways of treating primary hypertension: lifestyle modification or medication (or sometimes both).
Then there’s secondary hypertension, which means the individual’s high blood pressure has an identifiable cause…
For example, some medications like oral contraceptives, NSAIDs like ibuprofen, steroids and decongestants can cause secondary hypertension. High blood pressure can also be triggered by existing health issues like kidney disease, obstructive sleep apnea and Cushing’s syndrome.
However, the most common cause of secondary hypertension has to do with a part of the body, you hear little about… your adrenal glands.
Your adrenal glands sit right next to your kidneys and produce adrenaline. The outer portion produces hormones including cortisol for mental, emotional or physical stress needs. They also produce some sex hormones.
Adrenal glands also produce the hormone aldosterone — and overproduction of this hormone affects the body’s balance of salt and water.
And if you haven’t guessed, this excessive production is often caused by a tumor. Adrenal tumors are responsible for 15 percent of all hypertension cases in the U.S. — or about 10 million people.
Removal of the adrenal tumor usually normalizes the individual’s blood pressure. Unfortunately, only a fraction of patients are correctly diagnosed and treated for these tumors.
The problem with diagnosing adrenal tumors
For years, the presence of an adrenal tumor or adenoma was detected in one of two ways — both problematic…
One is invasive and involves sampling the blood leaving the adrenal gland.
In the second, noninvasive method, radiologists used an iodine agent to measure cholesterol uptake, which is a precursor to aldosterone. This test required patients to take steroids for a week before imaging and exposed them to high amounts of radiation.
The iodine agent used in the test was created by the University of Michigan in the 1970s. However, federal regulations caused it to be discontinued in the late 2000s.
Recently, a University of Michigan team developed a new agent that replaces iodine with fluorine-18, a radioisotope commonly used in PET scans. The researchers found that this method could allow screening for hypertension-linked adrenal tumors with significantly less radiation exposure.
“This agent gives us a noninvasive way to find out if aldosterone is being produced abnormally, one that significantly limits the potential harm to our patients through decreased exposure to radiation and limiting of steroid use,” says Dr. Benjamin Viglianti, senior author of the paper and a professor at University of Michigan Medical School.
“Adrenal adenoma, if identified, can be removed surgically, which can cure people of their hypertension,” Viglianti adds “This can help people with the disease by being deployed as a screening tool.”
When to test for a hypertension-causing adrenal tumor
If you’re suffering from resistant hypertension and your doctor hasn’t tested you for an adrenal tumor, it’s a good idea to broach the subject. But that’s not the only circumstance in which you should be tested.
If you fall into any of the following categories, you should have your doctor request an adrenal tumor diagnostic:
- Your hypertension requires two or more blood pressure medications to manage.
- You’re taking spironolactone (Aldactone), eplerenone (Inspra) or amiloride for hypertension.
- You have hypertension despite having none of the known risk factors (i.e., age, smoking, diabetes, obesity, kidney problems, etc.).
- You’re younger than 50 and have hypertension.
- Your hypertension is accompanied by hypokalemia, or low blood potassium.
- You have both hypertension and sleep apnea.
- You have hypertension and a family history of early-onset (younger than 50) hypertension or stroke at a young age.
- You have hypertension and one or more of your family members has had an adrenal tumor.
- Your hypertension is episodic, meaning it comes and goes.
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Researchers develop new agent to help root out hypertension-causing tumor — Michigan Health Lab
Development of Fluorinated NP-59: A Revival of Cholesterol Utilization Imaging with PET — Journal of Nuclear Medicine
Adrenal Tumors Causing High Blood Pressure (Hypertension) — Carling Adrenal Center
Endocrine Related Hypertension — Endocrine Society
Tired, depressed and hurting? It could be adrenal fatigue — Easy Health Options