[Non-controllable blood pressure peaks--pheochromocytoma?]

Area of Science:

• Cardiology
• Nephrology
• Vascular Medicine

Background:

• Arterial hypertension is a significant risk factor for cardiovascular disease.
• Refractory hypertension, uncontrolled by multiple medications, poses a clinical challenge.
• Renal artery stenosis is a potential underlying cause of secondary hypertension.

Observation:

• A 59-year-old patient presented with severe arterial hypertension resistant to a combination of ACE-inhibitors, diuretics, calcium channel blockers, and beta-blockers.
• Despite medication, blood pressure readings fluctuated significantly, reaching as high as 180/100 mmHg and dropping to 90 mmHg systolic post-dose.
• Duplex ultrasonography identified renal artery stenosis as the likely cause.

Findings:

• Percutaneous transluminal angioplasty with stent implantation was performed to treat the renal artery stenosis.
• Following the intervention, the patient's blood pressure normalized.
• Antihypertensive medications were discontinued, and blood pressure remained within normal limits.

Implications:

• Renal artery stenosis should be considered in cases of refractory hypertension.
• Endovascular treatment of renal artery stenosis can effectively manage severe, medication-resistant hypertension.
• Successful revascularization may lead to normalization of blood pressure and cessation of antihypertensive therapy.