Hypertension in young. Familial Hypertension?

A 27year old male patient had came to the General medicine Outpatient with the complaints of Headache, of 2 weeks duration, intermittent in nature not associated with nausea,vomiting,photophobia,neck pain.
H/o excessive sweating present even on slight exertion.
H/o Snoring present.
No h/o weakness in any limbs, paresthesias, palpitations, syncope, chest pain.
Past history:- K/c/o Hypertension-Diagnosed 1 and half year back-On Amlodepine 2.5mg OD 
Family history:
Hypertension in two elder brothers and one sister at a young age.
One brother was diagnosed to be hypertensive at the age of 29years..Was on medication and at the age of 40 he had a below knee amputation of both lower limbs done in v/o ?Ischemia(no documentation available) and then sudden demise happened.
Another brother was hypertensive at a young age...Had Stroke(CVA) and sudden death happened. 
H/o ?Seizures in both the brothers (as said by the patient)



On Examination at the time of admission-
Patient is conscious and oriented
There's no Pallor, Icterus,Clubbing, Cyanosis, Lymphadenopathy, Pedal edema. 

 


Anthropometry:
 Waist circumference: 95cms
 Height: 1.69 mts
 Waist to height ratio: 0.56





Pulse-100bpm,regular on left radial artery
-90bpm,regular on right radial artery
BP- 140/100mmhg in supine posture on rt arm
-170/120mmhg in supine posture on lt arm
Dorsalis pedis,popliteal and femoral pulses on left side were feeble.
CVS: S1S2 heard, No murmurs
Respiratory system: Normal Vesicular breath sounds are heard
Per abdominal examination: Soft, Non tender, all quadrants equally moving with respiration,
No organomegaly, No renal bruit heard.
CNS- HMF Intact

Provisional diagnosis- Familial hypertension in young? Secondary causes?

Investigations:

Following necessary investigations available in our set up were done.



As 24hr urinary VMA and metanephrine were not available, spot urinary VMA was done

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