Carotid endarterectomy unexpectedly resulted in optimal blood pressure control [Karotidna endarterektomija neočekivano rezultirala optimalnom kontrolom tlaka]

Kirin, Ivan and Kirin, Marijan and Sičaja, Mario and Missoni, Saša and Pehar, Mario and Prka, Željko and Špoljarić, Marko and Božikov, Velimir (2009) Carotid endarterectomy unexpectedly resulted in optimal blood pressure control [Karotidna endarterektomija neočekivano rezultirala optimalnom kontrolom tlaka]. Collegium Antropologicum, 33 (4). pp. 1229-1231. ISSN 0350-6134

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Abstract

Resistant hypertension is defined as hypertension that remains above 140/90 mmHg despite the provision of three or more antihypertensive drugs in a rational combination at full doses and including a diuretic. It is associated with adverse clinical outcome and therefore requires aggressive medical treatment. We present a case of 70-year-old woman who was treated for resistant hypertension with a diuretic, ACE-inhibitor, calcium channel blocker, and with centrally acting antihypertensive, moxonodine. Despite of aggressive medical treatment her blood pressure remained above 160/90 mmHg continuously. Large diagnostic workup excluded common causes of secondary hypertension, but revealed significant carotid stenosis present on left internal carotid artery. Carotid endarterectomy was performed in order to improve cerebrovascular prognosis, but unexpectedly resulted in optimal control of her blood pressure. Two months after operation patient was on only one antihypertensive drug, having blood pressure below 130/85 mmHg. We suggest that in selected patients resistant hypertension could be associated with carotid stenosis and carotid sinus baroreceptor dysfunction. For definite conclusions further studies are warranted.

Abstract in Croatian

Rezistentna hipertenzija definirana je kao povišeni krvni tlak iznad 140/90 mmHg unatoč liječenju sa tri ili više antihpertenziva u racionalnoj kombinaciji uz uključeni diuretik. Asocirana je sa nepovoljnom kliničkom prognozom i zahtjeva agresivno liječenje. Prezentiramo slučaj 70-godišnje bolesnice koja je liječena od rezistentne hipertenzije sa diuretikom, ACE-inhibitorom, blokatorom kalcijskih kanala uz centralno djelujući antihipertenziv, moksonidin. Unatoč agresivnom liječenju njezin je tlak bio kontinuirano iznad 160/90 mmHg. Opsežna dijagnostička obrada isključila je uobičajene uzroke sekundarne hipertenzije, ali je otkrila značajnu stenozu lijeve karotide. Učinjena je karotidna endarterektomija sa ciljem da se poboljša cerebrovaskularna prognoza bolesnice, a kao neočekivani postoperativni nalaz javila se normotenzija bolesnice. Na temelju kliničke opservacije sugeriramo da u selekcioniranih bolesnika rezistentna hipertenzija može biti asocirana sa stenozom karotide i disfukcijom karotidnih baroreceptora. Za definitivne zaključke potrebne su kliničke studije.

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