title: Truly resistant hypertension?
abstract: A young man presented with severe hypertension with evidence of both neurological and cardiovascular end-organ damage. Investigation revealed a small right kidney and a left renal artery aneurysm. Significant hypertension persisted even after right nephrectomy. Despite extensive investigation, no evidence was found to implicate the aneurysm in the causation of his high blood pressure. No alternative cause for hypertension was found, yet blood pressure was high even during hospital admission and observed medication dosing with eight antihypertensive agents. Sustained hypertension resulted in worsening left ventricular hypertrophy and he died suddenly at a tragically young age several years after presentation. This gentleman had truly resistant hypertension, a clinical problem which can be very difficult to manage.
authors.affiliation: Department of Nephrology, North Middlesex Hospital, London, UK. categoodlad@yahoo.co.uk
authors.forename: Cate
authors.initials: C
authors.lastname: Goodlad
authors.forename: Robert
authors.initials: R
authors.lastname: Unwin
authors.forename: David
authors.initials: D
authors.lastname: Reaich
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cross
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis; D000792:Angiography; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002878:Chromosomes, Human, Pair 1 / Q000235:genetics; D002889:Chromosomes, Human, Pair 2 / Q000235:genetics; D016757:Death, Sudden, Cardiac / Q000209:etiology; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006580:Genetic Carrier Screening; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000235:genetics; D006977:Hypertension, Renal / Q000175:diagnosis / Q000188:drug therapy; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000188:drug therapy; D007668:Kidney / Q000002:abnormalities; D008297:Male; D014178:Translocation, Genetic / Q000235:genetics
chemical_list: D000959:Antihypertensive Agents