Mazza Alberto, Ravenni Roberta, Armigliato Michela, Rossetti Ciro, Schiavon Laura, Fiorini Fulvio, Rigatelli Gianluca, Ramazzina Emilio, Casiglia Edoardo
Hypertension Centre Certified by the Italian Society of Hypertension, S. Maria della Misericordia Hospital, Rovigo, Italy.
Department of Internal Medicine, Chief of the Hypertension Centre, S. Maria della Misericordia General Hospital, Viale Tre Martiri No. 140, 45100, Rovigo, Italy.
High Blood Press Cardiovasc Prev. 2016 Mar;23(1):41-6. doi: 10.1007/s40292-015-0128-x. Epub 2016 Jan 4.
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.
To discuss an unusual presentation of uncontrolled hypertension despite multiple anti-hypertensive medications.
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.
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.
难治性高血压是一种临床病症，即在包括利尿剂以及至少另外两类抗高血压药物的药物治疗下，血压（BP）仍未得到控制。
探讨尽管使用了多种抗高血压药物，但高血压仍未得到控制的一种不寻常表现。
一名46岁女性患有难治性高血压（HT），并有长期多饮、多尿、体重减轻和精神症状（突然出现伴有自由焦虑、消极和乏力的人格障碍），使用抗抑郁药物治疗无效。继发性高血压检查显示，无论是在平卧位（分别为342 pg/ml和907 pmol/l）还是站立位（分别为351 pg/ml和2845 pmol/l），血清肾素和醛固酮均显著升高，低钾血症（2.9 mmol/l）和大量蛋白尿（431 mg/天）。诊断检查还发现右肾动脉近端约70%的局灶性狭窄并伴有狭窄后扩张。经皮球囊血管成形术和支架植入术后，使用5 mg/天氨氯地平使血压恢复正常，精神症状也突然消失。
精神病理症状在醛固酮增多症发病时较为罕见，其病因尚不明确。为了在短期至中期实现推荐的治疗目标并改善长期预后，必须进行适当的诊断和治疗过程。我们还建议，对于一名尽管使用了多种抗高血压药物但高血压仍未得到控制的年轻高血压患者，在未排除继发性高血压形式之前，不要认为其患有抑郁症或使用抗抑郁药进行治疗。
