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Malignant hypertension and pseudohyperaldosteronism associated with rifampicin therapy
Alexandre Szedleski1,2, Cédric Ilbert3, Véronique Goncette4
1Division of Nephrology, University of Liège Hospital (ULiège CHU), Liège, Belgium. alexandre.szedleski@uliege.be.
Cardiovascular Diabetology. Endocrinology Reports
|December 16, 2025
Summary
Rifampicin can cause severe, treatment-resistant arterial hypertension (high blood pressure) by inducing pseudohyperaldosteronism. Blood pressure normalized after discontinuing the drug, suggesting a direct causal link beyond typical drug interactions.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Arterial hypertension (HT) is a common condition.
- Rifampicin is an antibiotic used to treat infections like spondylodiscitis.
- Drug-induced hypertension can complicate treatment regimens.
Purpose of the Study:
- To report a case of severe, treatment-resistant arterial hypertension.
- To investigate the potential role of rifampicin in inducing this condition.
- To explore the underlying pathophysiological mechanisms.
Main Methods:
- Case report of a 64-year-old woman.
- Clinical observation of blood pressure changes.
- Assessment of antihypertensive therapy efficacy.
- Laboratory investigations for secondary causes of hypertension.
- Monitoring of blood pressure after drug withdrawal.
Main Results:
- The patient developed malignant, resistant arterial hypertension after starting rifampicin.
- Antihypertensive therapy provided only partial control.
- Evidence of pseudohyperaldosteronism was found.
- Blood pressure normalized upon rifampicin cessation.
- Other secondary causes of hypertension were excluded.
Conclusions:
- Rifampicin can be a direct cause of severe arterial hypertension.
- Mechanisms may involve cytochrome P450 induction and pregnane X receptor agonism.
- This highlights the need to consider rifampicin as a potential hypertensive agent.
- Pathophysiological mechanisms may extend beyond pharmacokinetic interactions.
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