24 yrs male patient presented with Left parieto-occipital headache with chest pain/palpitation off n on since last 6 months.ECG normal except sinus tachycardia. B.P .162/100,Pulse 108,SPo2 97. Sometimes c/o low backache,burning micturition.Vision normal. No giddiness, vomiting. Appetite /sleep normal. How to manage this case medically n what other investigations needed to label this as secondary hypertension as the age of patient is only 24 yrs.???

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Hyperlipidaemia with cholesterol 272 and VLDL more than 70 and hypertriglyceridaemia with TG 364 is the root cause of his complaints including hypertension, chest pain and palpitations. Associated anxiety may be related to sinus tachycardia. Prominence of bilateral pelvicalyceal system and 6 mm calculus with associated UTI could be associated with backache and burning micturition. An echocardiography is required to evaluate cardiac status. Tab Nebivolol 5 mg will take care of hypertension and tachycardia. Urinary alkalizer and excessive fluid intake will help .May be family history of hypertension and hyperlipidaemia

I agree with Dr. Praveen Yogaraj

As both renal sizes are normal, we can start ACE inhibitors to control BP. Next investigation for secondary htn should be 24 hr urine metanephrines to rule out pheochromocytoma/paraganglioma which can also cause low backache

I agree with Dr P Yograj

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