HYPERTENSION - HOCKEY PLAYER

Abstract

HISTORY A 21 year old Caucasian male collegiate hockey player was seen in the off season at the University Health Center for a laceration sustained while using a kitchen knife. The blood pressure at that time was noted to be significantly elevated and the athlete was referred to the team physician for further evaluation. Blood pressures recorded 8 and 12 months prior were normal. Further history revealed that the athlete had started on a creatine supplement 4 weeks prior. He reports he loaded with 5 gm/day for 4 days and was currently taking a maintenance dose of 5–10 mg/day. He denied use of any other supplements, herbal remidies, prescription or over the counter medications. He further denied use of any anabolic steroids, alcohol or illicit drugs including cocaine or amphetamines. Family history was positive for mother and sister with hypertension. There was no family history of hypercholesterolemia, renal disease, or premature coronary artery disease. PHYSICAL EXAM Generally, a healthy appearing male. Height 73 inches, weight 215 lbs. BP 158/92 RAS, 150/90 LAS. No orthostatic blood pressure changes were noted. Fundoscopic exam showed no AV nicking or hemorrhages. Skin exam was negative xanthomas. Arterial pulses were strong and equal. No carotid, renal or femoral bruits to auscultation. No JVD or thyromegally noted. Cardiac exam without murmur or extra heart sounds. Lung and abdomen exams normal. DIFFERENTIAL DIAGNOSIS Renal disease including renal artery stenosis, pyelonephritis and diabetic proteinuria; coarctation of the aorta; aldosterone producing adrenal disease; pheochromocytoma; sleep apnea; alcohol abuse; CNS lesions including CVA and tumor; drugs including decongestants, cyclosporine, street drugs; endocrinopathies including thyroid, parathyroid and pituitary etiologies. TESTS/RESULTS CBC, BUN, creatine, UA, blood glucose, TSH all normal. CLINICAL COURSE The patient was instructed to discontinue the use of creatine and serial BP measurements were taken. Within 6 weeks his BP returned to normal. Ten weeks later the athlete presented for his PPE and a BP of 180/120 was recorded. He stated he had restarted creatine 4 weeks prior because his blood pressure was back to normal. Again the athlete was instructed to discontinue creatine and held from athletic competition due to his elevated BP. Serial BP measurements taken over the ensuing 14 weks again showed a linear downward trend to normotensive values and the patient was cleared for athletic participation. FINAL WORKING DIAGNOSIS Hypertension secondary to creatine supplementation.