Objective: Renal denervation (RDN) is an emerging interventional option for the treatment of resistant hypertension. Hemochromatosis is a metabolic disorder characterized by iron accumulation and oxidative endothelial injury. The most prevalent form, type 1 hemochromatosis, is associated with homozygous C282Y or compound heterozygous C282Y/H63D mutations in the HFE gene. Although HFE H63D heterozygosity is common and generally considered clinically benign, increased sympathetic nervous system activity has been reported in individuals with iron overload. This case report highlights the importance of individualized evaluation of young patients with resistant hypertension and explores the potential role of RDN.Design and method: A 21-year-old male with resistant hypertension, paroxysmal tachycardia, and HFE H63D heterozygosity was evaluated. Stage 2 hypertension was diagnosed at 17 years of age. Despite triple antihypertensive therapy (perindopril/indapamide/amlodipine 10/2.5/10 mg), blood pressure remained uncontrolled. Ambulatory blood pressure monitoring (ABPM) revealed daytime isolated systolic hypertension and nocturnal combined systolic–diastolic hypertension with a non-dipping pattern. Central hemodynamic parameters, including aortic pressure, pulse wave velocity, and augmentation index, were within age-adjusted reference ranges. Laboratory findings showed polyglobulia, elevated ferritin (399.6 mcg/L), transferrin saturation of 87%, and markedly increased renin levels. Renal artery stenosis and anatomical abnormalities were excluded. Antihypertensive therapy was modified to valsartan/amlodipine 160/10 mg and moxonidine 0.4 mg. Bilateral RDN was performed using the Simplicity catheter in accordance with the Consensus of the Croatian Hypertension League. Follow-up ABPM demonstrated persistent hypertension, requiring re-escalation of pharmacological therapy. Results: This case illustrates the diagnostic and therapeutic challenges of hypertension in young patients. Increased sympathetic activity associated with iron overload provided the rationale for centrally acting antihypertensive therapy and RDN. The coexistence of polyglobulia may further aggravate hypertension by increasing blood viscosity, limiting the use of diuretics. Given the patient's young age, tachycardia, non-dipping pattern, and suspected sympathetic overactivity, RDN was considered an appropriate therapeutic option. Conclusions: RDN may represent a valuable adjunctive treatment in carefully selected young patients with resistant hypertension and pronounced sympathetic activation. Further studies are warranted to define its role in this population.
Jankov et al. (Fri,) studied this question.