[PP.10.25] AN UNEXPECTED ETIOLOGY FOR HYPERTENSION IN YOUNG WOMEN. (September 2016) - Homentcovschi, C.
Abstract : Objective: Introduction: One of the most common causes of secondary arterial hypertension in young women is the renal artery stenosis due to fibromuscular dysplasia, vasculitis or thrombembolic disease. We present the case of a patient with an unexpected, unilateral renal artery atherosclerotic lesion. Design and method: Case report: We describe the case of a 20 years old non-smoker and obese women (BMI = 31 kg/m2), with no personal or family history of cardiovascular diseases; she was diagnosed with hypertension at the age of 18, with maximal values of 200/120 mmHg. She was born premature (29 weeks) and had mild mental retardation; no other pathologies at the time of examination; was treated with four antihypertensive drugs (ACE- inhibitor, calcium blocker, central blocker and diuretic)- without a proper control. The clinical exam showed no abnormalities, without purple or red striae, symmetrical blood pressure at arms, symmetrical pulse and no carotid or renal bruits, no hirsutism. The routine laboratory tests demonstrated dyslipidemia- hypercholesterolemia (total cholesterol 210 mg/dl, LDL 130 mg/dl); in order to find a cause for secondary hypertension, we performed also TSH, FT4, testosteron, cortisol levels, that were normal, but an aldosterone-renin ratio was calculated and demonstrated high renin values. Results: The echography showed reduced flow through the right renal artery, an MRI of the renal arteries revealed a severe, unique, proximal stenosis of the right renal artery, a typical atherosclerotic lesion. After percutaneous dilatation - the hypertension control dramatically improved. No other stenosis were found elsewhere and practically we exclude fibromuscular dysplasia and Takayashu disease. Conclusions: It was a single, atherosclerotic- type lesion in a patient with obesity and mild hypercholesterolemia as risk factors, in a very young age. The interventional approach was mandatory and the good results justify the high cost diagnostic procedures. A particular issue in this patient is that she was a premature born, and the prematurity is associated later in life with accelerated atherosclerosis; this could be an additional factor that contributed to the patient's particular lesion. The aggressive management of the risk factors has to be the cornerstone for a lifelong therapy.