Severe and refractory hypertension in a young woman
| Autor: | William B. White, René H. Cuadra |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Nephrology medicine.medical_specialty Pediatrics Critical Care Coronary Vasospasm 030204 cardiovascular system & hematology Kidney Article Medication Adherence Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine Internal Medicine Humans Medicine 030212 general & internal medicine Dosing Young adult Intensive care medicine Referral and Consultation Antihypertensive Agents Depression business.industry Angiography Digital Subtraction Brain Blood Pressure Determination Glomerulonephritis IGA Emergency department medicine.disease Mental health Antidepressive Agents Clonidine Hospitalization Mental Health Coronary vasospasm Hypertension Administration Intravenous Female Emergency Service Hospital Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Magnetic Resonance Angiography Young person medicine.drug |
| Zdroj: | Journal of the American Society of Hypertension. 10:506-509 |
| ISSN: | 1933-1711 |
| DOI: | 10.1016/j.jash.2016.03.193 |
| Popis: | Refractory hypertension in a young person is an uncommon clinical problem, but one that may be referred to hypertension specialists. Factitious hypertension is fortunately quite rare but should be considered when evaluating patients who are refractory to numerous classes of antihypertensive therapies and have failed to achieve control despite input from multiple providers. A 19-year-old woman was referred to us after failing to achieve blood pressure control by a primary physician and two subspecialists in nephrology and hypertension; she also had numerous emergency department visits for symptomatic and severe hypertension. Exhaustive diagnostic testing for secondary causes and witnessed medication dosing in an outpatient setting was unrevealing. Subsequent inpatient admission demonstrated normalization of BPs with small doses of intravenous antihypertensive agents. During the hospitalization, she was observed "pocketing" her oral medications in the buccal folds and then discarding them in a trash container. Confrontation by psychiatrists and the hypertension specialists led to the admission that she had learned to start and stop beta-blockers and clonidine to induce severe, rebound hypertension. Factitious and induced hypertension is a rare cause of resistant or refractory hypertension. Nevertheless, hypertension specialists should suspect the diagnosis when there is a history of visits to multiple institutions and physicians, negative secondary workup, absence of overt target organ damage, history of psychiatric illness, and employment in the medical field. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|