When the „trivial“ hypertension leads you to the correct diagnosis

Introduction: Although hypertension (HTN) has an increased prevalence in the general population, it is also a disease incompletely elucidated from a pathophysiological point of view, interpreted as primary in 95% of cases. Thus, the trap in clinical practice is the temptation to consider in most cases that there is no underlying condition to explain the occurrence of hypertension. But the truth is sometimes found beyond these percentages, perhaps hidden on the patient’s face.

Methods: We present the case of a 45-year-old woman, affirmatively diagnosed with Lyme disease 4 years previously, with multiple consecutive antibiotic treatments, who is hospitalized for fronto-occipital heada-che amid increased blood pressure (BP) at home in the past days. She associates inspiratory dyspnea upon mo-derate exertion and low-grade fever witch started one week before, lower limbs edema that started two weeks ago, as well as polyarthralgia with joint stiffness in the last 3 months. Clinically there is fever, alopecia, oral ul-ceration, malar rash, generalized edema suggestive for „renal edema“ and persistently high BP.

Results: Blood tests showed pancytopenia, moderate normochromic normocytic anemia, hypoproteinemia with hypoalbuminemia, renal failure and marked in-flammatory syndrome. Radiologically and ultrasound reveals polyserositis. The mentioned elements, together with nephrotic proteinuria (5 g/24h), raise the suspicion of systemic lupus erythematosus (SLE). The di-agnosis is confirmed in a rheumatology clinic by the positivity of antinuclear antibodies, anti-dcDNA, anti-phospholipids and hypocomplementemia. Initiation of specific treatment led to slow, partial recovery of renal function and control of BP, however needing initially antihypertensives with anti-proteinuric effect (conver-sion enzyme inhibitor, lercarnidipine), beta-blocker and thiazide-like diuretic.

Conclusions: The particularities of this case consist in the late diagnosis, at the age of 45, of a secondary form of hypertension in the context of SLE, diagnosis that was made starting from the patient’s presentation to the emergency room for “trivial” hypertension, which sometimes can aid in unmasking a severe underling disease. Control of BP values was obtained only after the introduction of pathogenic treatment with methyl-prednisolone, being possible to further reduce the doses of antihypertensive treatment. Although the patient had an intensely active form of SLE with damage to a vital organ, a significant improvement in renal function was obtained.

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)