Quick Case: Accelerated Hypertension

Case Presentation

Patient Profile
Age: 50
Sex: Male
History: Nothing particular
Presenting complaints: Multiple migrating joint pains, feeling tired since 1 week.

Examination

  • Normal build
  • Pulse: 96/min
  • Blood Pressure: 220/130
  • Other things clinically NAD

Investigations

  • Patient was sent to the hospital for observation and control of blood pressure.
  • Admitted in ICU, basic work up was not conclusive.
  • In spite of IV medications, blood pressure was not coming under control.
  • Patient was subject to CT of abdomen with contrast.
  • This clinched the diagnosis: Bilateral Renal Artery Stenosis.
  • On angiogram, right renal artery was near 100%, left renal artery almost 90%.

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Diagnosis

Bilateral Renal Artery Stenosis. Patient is doing well after stenting procedure in both renal arteries and was discharged.

Learning Points/Take Home Messages

  • Always look for the cause of accelerated hypertension.
  • Do measure blood pressure of patients who are presenting with multiple vague complaints.
  • Encourage patients to get their blood pressure checked on a regular basis after a certain age.
  • Renal artery stenting remains the standard treatment in cases of symptomatic and significant renal artery stenosis.

About The Author

Dr. Vachharajani is an experienced practicing family physician in Ahmedabad, Gujarat, with a special interest in obesity and lifestyle-related disorders. With a genuine passion and enthusiasm for healthcare information technology (HIT), he has championed the cause of using HIT in day-to-day clinical practice. In addition to his, MBBS, he holds a post-graduate certificate in environmental and occupational health (PGDMCH).

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2 Comments

  1. Thomas Kuruvilla
    Posted Aug 2014 at 4:52 pm | Permalink

    Very interesting case! Thanks a lot. Did not the BP come down with IV nitroglycerine or IV nitroprusside infusion? It should have, isn’t it? There has to be a medical mode of management in addition to stenting because stenting is not possible in many settings. Oral calcium channel blockers, beta blockers may have helped.

    • Dr. Pragnesh Vachharajani
      Posted Aug 2014 at 3:27 pm | Permalink

      No,Sir.
      Pt was kept in ICU for 24 hours and all the above mentioned medications were tried. Then only the cardiologist opted for stenting.

      thanks.

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