A rare cause of resistant hypertension-polycythemia rubra vera

Introduction: Polycythemia rubra vera is the most common myeloproliferative disorder, sparing no adult age group. Resistant hypertension is one of the major cardiovascular complications, but the prevalence is still unknown.
Methods: We present a case of a 69 year old male, known with type 2 diabetes, hypertension third stage with an old inferior myocardial infarction treated with aorto-coronary bypass, which presents to the Clinic of Cardiology of the Cardiovascular Rehabilitation Hos-pital, Iași, for uncontrolled hypertension with pusatile headache and dyspnea to moderate exercise. Currently he is on a 4 antihypertensive drug regimen (beta-blocker, sartan, diuretic and a dihidropiridinic calcium channel blocker) with maximal doses.
Results: T he physical examination revealed facial erythrosis and laboratory explorations showed mode-rate polyglobulia with leukocytosis. The Ambulatory blood pressure monitoring revealed severe uncontro-lled blood pressure with an average of 170/100 mmHg, and noctural non-dipper profile. A hematological con-sultation was made, with the documentation of positive JAK2 mutation and low levels of serum erythropoetin. The diagnosis of polycythemia rubra vera was establi-shed. 2 phlebotomies were performed, and the patient started treatment with hydroxiurea 500 mgx4/day, and the antihypertensive treatment was readjusted. After 1 month, the patient was asymptomatic, the polyglobulia was significantly reduced and the mean 24h blood pre-ssure was 150/80 mmHg.
Conclusions: Polycythemia rubra vera is a rare cause of resistant hypertension and usually requires complex antihypertensive treatment for optimal blood pressure control. Early diagnosis and treatment is the key com-ponent in reducing the long-term cardiovascular risk for these patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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