327 Secondary Hypertension – When Is It Reasonable To Think About It? A Case Report

Barros J, Galhardo M, Costa M, Ferreira J
Aim(s) and background: Arterial hypertension (AH) is an increasingly important medical and public health issue showing a strong correlation with increasing age and cardiovascular disease. Of all hypertensive patients, nearly 85-90% has essential AH; the remainder have secondary causes. Our aim is to enhance the role of the family physician in recognizing the hypertensive patients that should be screened for secondary HA and refer to hospital care to complete the following study in selected cases.
Material and methods: We describe the case of MNAM, female, 60 years old, Caucasian, with a recent diagnosis of AH stage 1 (under medication), sedentary lifestyle, family history of AH and no history of recent medication affecting blood pressure (BP), who went in December of 2010 to emergency because of an episode of high BP level (180/100 mmHg).
Results: After the emergency episode, she went to her family physician, in December of 2010. Her previous studies (routine blood tests, ECG, transthoracic echocardiogram) showed no abnormalities. On physical examination she had a BP of 145/80 mmHg with no other relevant features. She went to a private physician who requested several diagnostic exams including an abdominal TC angiography that showed a significant stenosis of the right renal artery due to an atherosclerotic plaque. The patient showed the results to her family physician who decided to refer her to a hospital consultation of Internal Medicine to proceed with the study and possible diagnosis of a secondary AH. Additional imaging studies were negative for renovascular AH. It was concluded that the patient has an essential AH and the renal atherosclerotic stenosis was an incidental finding.
Conclusions: This case highlights the importance of the right selection of hypertensive patients for secondary AH screening, with the risk of detecting incidental findings using unreasonable complementary studies.
Secondary hypertension – when is it reasonable to think about it? A case report