Secondary hypertension – a diagnostic challenge

Introduction: Arterial hypertension is an important cardiovascular risk factor with destructive effects on the cardio-renal axis and it continues to represent a diagnostic and therapeutic challenge. Approximately 10% of the hypertensive population suffers from the secondary form of this pathology, a form with identi-fiable etiology and potentially curable. When clinical signs are insufficient to decipher the etiopathogenicity of the disorder and to discern between the essential and the secondary forms, an interdisciplinary approach be-comes imperative.

Methods: We hereby present the case of a 47-year-old patient with therapeutically neglected hypertension who develops an ischemic stroke, context in which very high blood pressure values (SBP 280 mmHg) and renal impairment are observed. After neuro-motor recovery, he is addressed to our clinic because of persistent high blood pressure values, despite medication compliance. Results: Laboratory findings revealed elevated creati-nine and hypokalaemia. Transthoracic echocardiogra-phy revealed left ventricular concentric hypertrophy, type 2 diastolic dysfunction and subclinical systolic dysfunction. The renal angiogram was normal. Aldost-erone and plasma renin were dosed, with an elevated aldosterone/renin ratio. The tomographic computer exam revealed the presence of two nodular formations in the right adrenal gland. The diagnosis of primary hyperaldosteronism was established. After the associa-tion of an antialdosteronic agent, a better control of the tensional values was obtained together with the correc-tion of hypokalaemia. The patient was directed for the surgical treatment of the lesion.

Conclusions: Primary hyperaldosteronism accounts for 10-20% of resistant hypertension cases, and unila-teral adrenal adenomas are the second most common cause (35% of cases) after bilateral idiopathic hyper-plasia. When untreated, it is associated with an increa-sed rate of arrhythmias, coronary artery disease, heart failure, stroke, proteinuria and renal dysfunction. The gold standard for the treatment of unilateral adenomas is surgical resection.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)