title: Mood Disorders in Uncontrolled Hypertension Despite Multiple Anti-Hypertensive Medications: Searching for a Link.
abstract: BACKGROUND
  Resistant hypertension is a clinical condition in which blood pressure (BP) control is not achieved under a pharmacological therapy including a diuretic and at least two additional antihypertensive drug classes.
  
  
  OBJECTIVE
  To discuss an unusual presentation of uncontrolled hypertension despite multiple anti-hypertensive medications.
  
  
  RESULTS
  A 46-year-old woman presented with resistant hypertension (HT) and with a long history of polydipsia, polyuria, weight loss and psychiatric symptoms (sudden onset of personality disorder with free anxiety, negativism and asthenia) unsuccessfully treated with antidepressant drugs. Tests for secondary HT showed a marked increase of serum renin and aldosterone both in clinostatic (342 pg/ml and 907 pmol/l, respectively) and orthostatic posture (351 pg/ml and 2845 pmol/l, respectively), hypokalemia (2.9 mmol/l) and macroalbuminuria (431 mg/day). Diagnostic examinations also revealed a focal stenosis of approximately 70 % of the proximal right renal artery with post-stenotic dilation. After percutaneous balloon angioplasty and stent implantation, BP was normalized with 5 mg/day amlodipine and psychiatric symptoms suddenly disappeared.
  
  
  CONCLUSIONS
  Psychopathological symptoms are rare at the onset of hyperaldosteronism, and their aetiology is not well defined. A proper diagnostic and therapeutic process is mandatory in order to get the recommended therapeutic targets in short-midterm improving long-term prognosis. We also suggest not considering depressed or treat with antidepressant agents a young hypertensive subject with uncontrolled hypertension despite multiple anti-hypertensive medications without having ruled out a secondary form of hypertension.
authors.affiliation: Hypertension Centre Certified by the Italian Society of Hypertension, S. Maria della Misericordia Hospital, Rovigo, Italy. mazza.alberto@azisanrovigo.it.|Department of Internal Medicine, Chief of the Hypertension Centre, S. Maria della Misericordia General Hospital, Viale Tre Martiri No. 140, 45100, Rovigo, Italy. mazza.alberto@azisanrovigo.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Department of Neuroscience, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ravenni
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Armigliato
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Rossetti
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Schiavon
authors.affiliation: Department of Specialistic Medicine, Nephrology, Dialysis and Dietology Unit, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Fiorini
authors.affiliation: Interventional Cardiology Unit, Division of Cardiology, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramazzina
authors.affiliation: Department of Medicine, Unit of Vascular Medicine, University of Padova, Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
mesh_terms: D000339:Affect; D000800:Angioplasty, Balloon / Q000295:instrumentation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
chemical_list: D000959:Antihypertensive Agents
keywords: Anxiety; Depression; Pseudo-resistant hypertension; Renin-angiotensin system