Hypertension That Doesn’t Give Up

Abstract

Background: Resistant hypertension is a condition in which blood pressure remains high (>140/90) despite taking at least three antihypertensive drugs, one of which is a diuretic.

Case History: A 46-year-old man comes to our department due to high blood pressure despite therapy. He appears alert and oriented. No headache or visual disturbances. BMI 46. Score2: 8.4%. APR: sleeve gastrectomy. TD: ACE inhibitor, dihydropyridine calcium antagonist, thiazide diuretic. AF: the mother died of ischemic stroke. ECG RS. Blood tests: in order. Echocardiogram: mild left ventricular hypertrophy, EF 55%. Renal ECD: kidneys within limits with normal vascularization. ECOTSA: absence of plaques or flow alterations. CT chest abdomen: nothing relevant.

Therapy is modified: transdermal clonidine, amlodipine 10 mg, furosemide 25 mg, amiloride 5 mg, hydrochlorothiazide 50 mg, ramipril 10 mg, labetalol 100 mg, methyldopa 250 mg, cardioaspirin 100 mg, pantorc 40 mg. The patient does not tolerate nitro derivatives. The dosage of renin and aldosterone is in range. Suppression test with dexamethasone is performed which allows to exclude Cushing’s disease. Thyroid function in order. Polygraphy: moderate OSAS with indication for CPAP.