Diagnostic surprise in the case of a patient with multiple cardiovascular risk factors

Introducere: Patients with multiple cardiovascular risk factors may have difficulties in controlling blood pressure.
Case presentation: We present the case of a 55-year-old woman, hypertensive, diabetic, dyslipidemic, obese, with history of angina pectoris, stent angioplasty on LAD, peripheral arterial disease, repeated ischemic stroke, under complex antihypertensive therapy, who presented for newly-onset symptomatic elevated blood pressure values. Renal function, thyroid hormones, plasma and urinary cortisol, serum aldosterone and urinary metanephrine were within normal range. Plasma renin was very high. Abdominal ultrasound and renal artery Doppler did not detect significant changes of the kidneys. Angio-CT of renal arteries revealed circumferential plaques of calcified atherosclerosis of abdominal aorta and right kidney artery with 90% ste-nosis at origin.
The antihypertensive treatment regimen was modified with suboptimal control of blood pressure values, the patient being directed to interventional cardiology for renal arteriography and angioplasty.
Conclusions: In a patient with multiple cardiovascular risk factors evolving from a young age, with systemic atherosclerosis, the lack of control of bllod pressure under complex treatment requires investigation of se-condary causes of arterial hypertension, especially the exploration of renal arteries for a possible renal artery stenosis and estimation of oportunity for renal angioplasty.

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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