PS 17-10 RECOVERY OR RECURRENCE? FOLLOW UP COURSE IN A PATIENT WITH SECONDARY HYPERTENSION

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Abstract

Objective:

1. To discuss a young patient with secondary hypertension diagnosed to have fibromuscular dysplasia (FMD).

Objective:

2. To understand the rates of recurrence of patients with FMD after interventional therapy.

Objective:

3. To discuss the clinical course of the patient two years after initial intervention of FMD.

Design and method:

This is a case of a young lady who was worked up in the General Medicine Clinic for secondary causes of hypertension. She was eventually diagnosed to have fibromuscular dysplasia (FMD), for which she underwent renal artery angioplasty. She has been weaned off from antihypertensive therapy and on regular follow-up at the General Medicine (Hypertension Specialty) Clinic. We discuss here the clinical course of the patient whilst on follow up, as well as the risks of recurrence after undergoing angioplasty. (Poster initially presented at Joint ESH-ISH Meeting in Athens last June 2014).

Results:

The patient is a 34 year old lady currently on follow up with the Hypertension Clinic. Initial workup showed hypokalemia, elevated renin and aldosterone levels. There was no evidence of renal artery stenosis. Renal arteriography showed beaded appearance with severe stenosis and aneurysmal dilatation of mid to distal right renal artery, suspicious of FMD. Early FMD noted on mid and distal third of left renal artery. Patient underwent balloon angioplasty of the right renal artery. Renin and aldosterone levels decreased six months after the procedure, and patient has been completely off from antihypertensive therapy. Two years unto clinic follow-up, her blood pressure remains at 110–120 mmHg systolic and has been asymptomatic.

Conclusions:

It is of utmost importance to closely follow-up patients with FMD even after successful balloon angioplasty due to risk of recurrence, renal or extra-renal (such as stroke or transient ischemic attack). The risk is higher for our patient due to presence of early FMD on the contralateral renal artery.

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