Renin dependent hypertension by dissecting aortic aneurysm. A case report

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Vascular Surgery

Background:

• A 49-year-old female presented with dissecting aortic aneurysm and severe hypertension.
• The patient had a history of poorly controlled blood pressure.

Observation:

• Aortogram confirmed De Bakey type IIIb aortic dissection extending to the iliac artery.
• Left renal artery occlusion was noted as a complication of the dissection.
• Peripheral plasma renin activity was found to be extremely elevated.

Findings:

• Administration of 1-Sar-8-Ile-angiotensin II, a renin-angiotensin system inhibitor, resulted in a significant reduction in blood pressure.
• The patient was managed conservatively with antihypertensive agents for approximately four years.

Implications:

• This case suggests a potential role for the renin-angiotensin system in the pathophysiology of complex aortic dissections.
• Understanding these mechanisms may inform future therapeutic strategies for patients with aortic aneurysms and hypertension.
• Conservative management of such complex cases can be prolonged but carries risks, as evidenced by the patient's sudden death.