For more than two decades, I treated patients with hypertension while quietly managing my own diagnosis of high blood pressure. As a family physician, I understood the guidelines, the medications, and the risks. But despite doing many of the “right” things, including staying active, maintaining a healthy weight, and later transitioning to a plant-based diet, my blood pressure remained difficult to control.
Eventually, after years of searching for answers, I was diagnosed with a condition called Primary Hyperaldosteronism, also known as Conn syndrome.
This journey changed me not only as a physician, but also as a patient. It reminded me how important it is to listen to your body, ask questions, and advocate for yourself when something does not feel right.
The Day Everything Changed
I was 32 years old when I was first diagnosed with hypertension. Just six months earlier, my blood pressure had been perfectly normal at 120/80. Then during an insurance physical performed in my office after a busy morning clinic, my blood pressure measured 160/100.
At first, I assumed it was stress. I had been rushing around seeing patients all morning. But repeat readings over time confirmed that I truly had high blood pressure.
Like many patients, my initial diagnosis was thought to be “essential” or primary hypertension, the most common form of high blood pressure. My mother also had hypertension, and family history significantly increases risk.
Still, something never completely fit.
Understanding the Two Main Types of Hypertension
There are two major categories of hypertension:
Primary (Essential) Hypertension
This accounts for about 90 to 95 percent of hypertension cases. It develops gradually and is often influenced by genetics, lifestyle factors, age, diet, stress, and physical activity levels.
Secondary Hypertension
This type is caused by an identifiable medical condition. Secondary hypertension accounts for approximately 5 to 10 percent of cases and may be related to:
- Kidney disease
- Thyroid disorders
- Sleep apnea
- Certain medications
- Hormonal disorders involving the adrenal glands
Unlike essential hypertension, secondary hypertension sometimes has a treatable or even curable cause.
Because I was young and otherwise healthy at diagnosis, my physicians appropriately ordered testing to look for secondary causes. At the time, however, everything appeared normal.
Living With Hypertension for More Than 20 Years
Over the years, I tried multiple medications and combinations of medications to control my blood pressure.
Some worked temporarily. Others caused side effects.
I developed a persistent cough while taking ACE inhibitor medications, which is a known side effect that occurs more commonly in African Americans. I eventually switched to ARB medications instead.
At times, I required as many as four medications to control my blood pressure.
Meanwhile, I continued exercising regularly, avoided smoking, drank alcohol only socially, and maintained a healthy lifestyle overall.
Then came another major shift in my health journey.
Transitioning to a Plant-Based Diet
In 2020, during the pandemic, I adopted a whole food plant-based diet.
The results were impressive.
Within months, my cholesterol levels improved dramatically, even though they had already been considered normal before the dietary change. I felt encouraged by the positive impact nutrition was having on my health.
But one thing did not improve.
My blood pressure remained stubbornly elevated.
As a physician, that raised concern for me. Lifestyle changes often help support healthy blood pressure, but despite my efforts, something still seemed off.
What Is Primary Hyperaldosteronism?
Primary Hyperaldosteronism is a hormonal disorder in which the adrenal glands produce too much aldosterone.
Aldosterone helps regulate sodium and potassium balance in the body. When too much aldosterone is produced:
- The body retains excess sodium
- Potassium levels may drop
- Blood pressure rises
Over time, this condition can increase the risk of:
- Heart disease
- Stroke
- Kidney damage
- Abnormal heart rhythms
The condition may be caused by:
- A benign adrenal tumor called an adenoma
- Enlargement of both adrenal glands
The Clue That Changed Everything
One subtle clue throughout the years was my potassium level.
It occasionally dipped below normal, although there were always possible explanations. Some blood pressure medications can affect potassium levels, so the abnormal results never seemed definitive.
Eventually, I referred myself to a nephrologist, a kidney specialist.
Further testing revealed mild kidney damage, which prompted additional imaging studies.
That is when doctors discovered a small adenoma on my left adrenal gland.
What Are the Adrenal Glands?
The adrenal glands are small glands that sit on top of the kidneys. They produce hormones that help regulate:
- Blood pressure
- Metabolism
- Stress response
- Salt and fluid balance
My adrenal adenoma was small, approximately the size of a pencil eraser, but size does not necessarily predict hormonal activity.
The important question was whether the growth was actually producing excess aldosterone.
The Importance of Hormone Testing
My endocrinologist ordered specialized hormone testing that compared aldosterone and renin levels.
The results were striking.
The normal aldosterone-to-renin ratio is typically between 0 and 30.
Mine was 70.
That strongly suggested primary hyperaldosteronism.
What Is Adrenal Vein Sampling?
To determine whether one or both adrenal glands were overproducing hormone, I underwent a procedure called adrenal vein sampling (AVS).
This highly specialized procedure involves sampling blood directly from the veins draining each adrenal gland to measure hormone production.
This distinction matters enormously because:
- If only one adrenal gland is affected, surgery may potentially cure the condition
- If both glands are overactive, treatment usually involves lifelong medication
My testing showed very high aldosterone production from the left side, strongly suggesting the adenoma was functioning.
Lessons I Learned as Both Doctor and Patient
Being on the other side of medicine taught me several important lessons.
Patients Know When Something Feels Wrong
Even when tests are initially normal, persistent symptoms or difficult-to-control conditions deserve continued evaluation.
Hypertension Is Not Always “Just Genetics”
Family history matters, but it should not stop us from looking deeper when the clinical picture does not fully add up.
Lifestyle Changes Matter Even When They Are Not the Entire Answer
My plant-based diet significantly improved my cholesterol and overall health, even though it did not fully resolve my blood pressure issue.
Self-Advocacy Is Important
Seeking additional opinions and asking questions can make a major difference in uncovering overlooked diagnoses.
Symptoms of Primary Hyperaldosteronism
Many people with Primary Hyperaldosteronism may not realize they have it. Possible signs include:
- High blood pressure requiring multiple medications
- Low potassium levels
- Muscle weakness
- Fatigue
- Headaches
- Excessive thirst
- Frequent urination
Some people have no symptoms beyond difficult-to-control hypertension.
Who Should Consider Evaluation?
You may want to discuss screening with your healthcare provider if you have:
- High blood pressure at a young age
- Resistant hypertension requiring several medications
- Low potassium levels
- A family history of early hypertension or stroke
- An adrenal mass found on imaging
DOCTOR’S ORDER
High blood pressure is common, but not all hypertension is the same. If your blood pressure remains difficult to control despite healthy lifestyle changes and medication, it may be worth discussing secondary causes with your physician.
A nutritious plant-based lifestyle can support cardiovascular health, but persistent hypertension should never be ignored or automatically dismissed as “just genetics.”
Listening to your body and continuing to ask questions can sometimes uncover answers that change your health journey entirely.
This experience reminded me that physicians are patients too. We experience uncertainty, fear, frustration, and vulnerability just like everyone else.
My hope in sharing this story is that it encourages others to stay informed, stay proactive, and understand that persistent health concerns deserve careful evaluation.
Sometimes the answer is more complex than it first appears. And sometimes finding that answer can change everything.
