title: [Itraconazole: a new drug-related cause of hypertension].
abstract: Itraconazole is a triazole agent used in the treatment of fungal infections and in some metastatic cancers. Its use has been associated with cardiovascular adverse events and particularly heart failure with preserved ejection fraction. We report the case of a 68-year-old male patient with a well-controlled hypertension treated with irbesartan 150mg/day since 2007. He developed a pulmonary aspergillosis on post-tuberculosis cavitary lesions treated in July 2011 with itraconazole 200mg/day. Early 2012, his antihypertensive treatment had to be gradually increased to a quadritherapy and his blood pressure was at 157/78mmHg at home. Hypokalemia was observed on several occasions as well as edema of the lower limbs. Plasma renin and plasma and urine aldosterone concentrations on treatment not interfering with the renin angiotensin system were low, associated with normal serum and urine cortisol, ACTH, SDHA and DOC, BNP and creatinine concentrations. Plasma itraconazole values were much above the therapeutic range. Left ventricular ejection fraction was preserved. There were no adrenal or renal artery abnormalities at the CT scan. Three months after stopping itraconazole, hypokalemia and edema disappeared and blood pressure was normalized with less treatment. Plasma renin and aldosterone concentrations were normalized. He had a pulmonary lobectomy for his pulmonary aspergillosis. Itraconazole may induce a resistant hypertension with low renin. The mechanisms of this adverse effect of itraconazole remain unknown.
authors: Hôpital Arthur-Gardiner, 1, rue Henri-Dunant, 35800 Dinard, France. Electronic address: denolle.thierry@wanadoo.fr.
authors: T
authors: T
authors: Denolle
authors: Unité d'HTA, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
authors: M
authors: M
authors: Azizi
authors: Hôpital Pontchaillou, 35000 Rennes, France.
authors: C
authors: C
authors: Massart
authors: Inserm U 970, service de génétique, hôpital européen Georges-Pompidou, université Paris Descartes, 75015 Paris, France.
authors: M C
authors: MC
authors: Zennaro
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D017964:Itraconazole / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D055732:Pulmonary Aspergillosis / Q000188:drug therapy; D028761:Withholding Treatment
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole
keywords: HTA iatrogène; HTA résistante itraconazole; Iatrogenic hypertension; Resistant hypertension itraconazole