A 30-year-old male patient _known to have celiac disease and not compliant with gluten-free diet_ has been accidentally discovered to have hypertension (150/90).
What are the possible causes?
How does the BP was meassured when hypertension was diagnosed? A 24-hour ambulatory meassure would be better if the case definition is debatable. If the diagnosis of hypertension was correctly made I´d look for secondary causes of hypertension: Primary kidney disease, primary aldosteronism or sleep apnea syndrome and other endocrine disorders ( hypothyroidism and primary hyperparathyroidism).
This is not a great finding, because sometimes you can find BP around these figures in the general population, so-called "essential hypertension". Before doing more studies you must control periodically this figures to see if they stabilize goes up or come down spontaneously. I don´t know any relationship with celiac disease
The patient is a young man and is not usual to have that BP. First explore the DX of hypertension, taking multiple readings in all the limbs at several different occasions. Take a full Hx of medications, prescription and over the counter, herbal etc. request a test for drugs in urine and blood. If all that confirms a high BP and is not caused by drugs or the white coat effect. Explore thyroid, renal and adrenal functions. Celiac disease can present with multiple organs involvement either because the intestinal malabsorption and/or because associated autoimmune conditions particularly endocrine organs, Is there other symptoms suggestive of thyrotoxicosis ect.?.
A young hypertensive must be investigated for certain conditions e.g. medical renal disease and renal artery stenosis (USG kidneys, renal function tests, DTPA scan), vascular diseases (coarctation of aorta, Takayasu disease manifested by unequal pulses in extremities and detected by angiography), endocrine disease (Conn's disease i.e. primary hyperaldosteronism, thyroid disorders, pheochromocytoma). Other factors like obesity, Drug abuse and family history of hypertension. Celiac disease as a direct cause of hypertension is rare but not unknown. The vascular endothelium maintains a relatively vasodilated state via the release of nitric oxide, a process that could be disrupted by hyperhomocysteinaemia due to Vitamin B 12 malabsorption in celiac disease (Vit B12 and other cofactors are involved in homocysteine metabolism). This cause systemic vasoconstriction and endothelial dysfunction resulting in hypertension. In such cases treatment with multivitamins can help
I agree with Dr Ray. Havnt really come across reports of a connect with hypertension and CD. But indirectly yes, homocysteine metabolism is influenced by MAS. This could be the potential cause!
