Tolu Seda, Kumar Neelja, Arora Shitij
Medicine, Montefiore Medical Center, Bronx, USA.
Nephrology, Montefiore Medical Center, Bronx, USA.
Cureus. 2021 Jun 16;13(6):e15698. doi: 10.7759/cureus.15698. eCollection 2021 Jun.
Hypertension is an important modifiable risk factor for cardiovascular disease and stroke. Most cases are diagnosed as essential hypertension however, in some patients, a secondary (and potentially curable) cause is identified. Selecting the right patient to screen for a secondary cause can be challenging and certain clinical and laboratory characteristics can guide work-up. We report a case of a 67-year-old man who presented with intracranial hemorrhage. He had a history of resistant hypertension for three decades and chronic hypokalemia while on a non-diuretic antihypertensive regimen. We discuss our approach to a hypertensive hypokalemic phenotype that led to the diagnosis of Liddle's syndrome with complete amelioration of hypokalemia with directed therapy. This case highlights the importance of accurate and early screening for causes of secondary hypertension in the outpatient community, and in doing so, preventing downstream catastrophic outcomes. It is imperative to develop a clear, concise approach to secondary hypertension, and raising awareness for the importance of early diagnosis as it can potentially avoid downstream sequela.
高血压是心血管疾病和中风的一个重要可改变风险因素。大多数病例被诊断为原发性高血压，然而，在一些患者中，可确定继发性（且可能可治愈）病因。选择合适的患者进行继发性病因筛查具有挑战性，某些临床和实验室特征可指导检查工作。我们报告一例67岁男性患者，其因颅内出血就诊。他有三十年难治性高血压病史，在使用非利尿剂抗高血压方案期间伴有慢性低钾血症。我们讨论了针对高血压低钾血症表型的处理方法，该方法导致了利德尔综合征的诊断，并通过针对性治疗使低钾血症完全改善。该病例强调了在门诊社区准确、早期筛查继发性高血压病因的重要性，这样做可预防下游灾难性后果。必须制定一种清晰、简洁的继发性高血压处理方法，并提高对早期诊断重要性的认识，因为这有可能避免下游后遗症。
