Thang was diagnosed with hypertension at 14 years old. Three years ago, he was hospitalized with Covid-19, where he was found to have heart and kidney failure. In recent two months, he experienced shortness of breath. He sought treatment at Tam Anh General Hospital Ho Chi Minh City, weighing 150 kg with a body mass index (BMI) of 46.9, indicating severe obesity, and a blood pressure reading of 200/110 mmHg.

Doctor Do Anh Tuan, Specialist Level I, from Cardiology Department 1, Heart Center, ordered an echocardiogram. The results showed dilation of all four heart chambers, severe heart failure, and pulmonary hypertension. Glomerular filtration rate (eGFR) tests indicated 15 mL/minute/1.73 m² (normal for ages 20-29 is >116 mL/minute/1.73 m²), consistent with kidney failure stages 4-5. Thang also suffered retinal damage due to hypertension.

According to Doctor Tuan, developing hypertension at 14 years old is very early. Potential causes include glomerular disease, renal vascular disease, endocrine disorders, aortic coarctation, or Takayasu arteritis.

"Thang may have had glomerular disease since childhood, manifesting as hypertension. The condition then silently progressed for many years, leading to severe chronic kidney disease complications today," Doctor Tuan stated.

Doctor Tuan checks the patient's health before discharge. *Photo: Tam Anh General Hospital*

Doctors treated his heart failure and hypertension with diuretics to reduce fluid retention. They also addressed electrolyte imbalances and adjusted his diet. After one week, Thang's blood pressure decreased to 140-150/100 mmHg, and his estimated glomerular filtration rate increased from 15 to 17 ml/minute/1.73 m². He lost 18 kg due to effective fluid removal.

Thang was discharged with instructions to take medication regularly, monitor his blood pressure, develop a safe weight loss plan, and attend follow-up appointments. Given his low glomerular filtration rate, he also receives concurrent treatment at the Nephrology Department to reduce the risk of progressing to end-stage kidney failure.

Master of Medicine, Doctor Huynh Thanh Kieu, Head of Cardiology Department 1, Heart Center, Tam Anh General Hospital Ho Chi Minh City, explained that hypertension and kidney disease often have a bidirectional relationship. Kidney disease can cause hypertension, and conversely, prolonged, uncontrolled high blood pressure damages small blood vessels and glomeruli.

Doctor Kieu further explained that severe obesity is a risk factor for hypertension. The accumulation of excess fat increases pressure on the heart and blood vessels, making it harder for the heart to pump blood. This leads to increased vascular resistance and, consequently, higher blood pressure. Obesity also contributes to type 2 diabetes, dyslipidemia, fatty liver disease, obstructive sleep apnea, heart failure, and atrial fibrillation.

Individuals with obesity should undergo regular health check-ups, blood pressure monitoring, and metabolic risk factor assessments. Doctors may recommend blood and urine tests, kidney function assessments, renal ultrasounds, and specialized tests to identify secondary causes, ensure correct treatment, and prevent complications.

Thu Ha

*Patient's name has been changed