Is It High Blood Pressure? Or Something Else?

Have high blood pressure? Seems like many of us do these days.

We often blame our diet, but even those of us who seem to check off all the healthy boxes can have problems controlling blood pressure.

So maybe you should be asking the question, “How’s my adrenal gland doing?”

Wait, what?

“High levels of aldosterone—which is a hormone produced and secreted by the adrenal glands—can lead to high blood pressure, especially hard-to-control blood pressure,” said Dr. Aaron Bolduc, surgical director of the Augusta University Health Adrenal Center.

It’s called primary hyperaldosteronism (PA), and while high blood pressure might be the only sign that someone has it, other symptoms could include weakness, tingling, muscle spasms, fatigue, headache, irregular heart rhythm and even intermittent temporary paralysis.

PA is actually the most common cause of reversible hypertension, affecting 5% to 18% of adults who have high blood pressure.

So What’s the Deal With the Adrenal Gland?

Each of us has two adrenal glands. The tiny triangular glands—only about an inch by three inches—sit on top of our kidneys. One of the main roles of the adrenal gland is to help regulate potassium and sodium levels in our bodies by producing aldosterone. Too much aldosterone makes our kidneys release more potassium and hold onto more sodium. “This leads to fluid retention and increased blood pressure,” said Bolduc.

It’s estimated that about 60% of patients with high levels of aldosterone have overactivity in both adrenal glands. For another 30%, the problem is an aldosterone-producing tumor on one adrenal gland.

Is My Adrenal Gland the Problem?

For anyone struggling to control high blood pressure, taking a look at the adrenal gland might be a good idea if:

You have sustained high blood pressure >150/100 mm Hg, confirmed on separate days;
Your blood pressure is >140/90 mm Hg, and you’re on three antihypertensive medications, including a water pill;
Your blood pressure is <140/90 mm Hg, but you’re on four or more antihypertensive medications.
You have high blood pressure and one of the following:
Drops in your potassium level in your blood;
An adrenal mass;
Sleep apnea;
Family history of early onset high blood pressure or stroke at a young age (<40 years of age);
First-degree relative with primary aldosteronism.

Your doctor will likely do laboratory testing, special studies such as a CT scan or MRI, or possibly adrenal vein sampling (a blood sample) to check for tumors or high levels of aldosterone.

What Are My Treatment Options?

If you have an adrenal tumor that’s making your gland produce too much aldosterone, surgery is usually recommended. It’s important to look for a surgical center that specializes in taking care of the adrenal gland since the surgery is so complex.

About half of patients who have surgery will find that their blood pressure returns to normal, says Bolduc. “The remaining patients may still have some high blood pressure due to other causes, but will likely be able to reduce their medications,” he said.

Almost all patients have normal potassium levels after surgery.

For patients with an adrenal mass who aren’t surgical candidates or for patients who have overactivity of both adrenal glands, medications like spironolactone can help block the activity of aldosterone, which should help gain better control of blood pressure.

“Just like any form of high blood pressure, it’s important to treat PA since having a persistent elevation in blood pressure can damage your heart and kidneys, leading to a heart attack, heart failure, other heart problems, stroke, kidney disease or failure,” said Bolduc. “It can also increase risk for diabetes, and patients with PA-related hypertension tend to do worse than those with essential hypertension. “But here’s the good news: It is treatable, and patients who get treatment tend to do very well.”