Hypertension - A Misleading Condition

Objective: A smoker, hypertensive, 64years-old male is hospitalized for faintness occurred two hours before presentation. ABPM before admission: 63% hypertensive load, nondipper profile. Design and method: Clinic: conscious, no headaches, no nystagmus, no motor deficiency, BP = 160/80mmHg, 60/min, regular, no valve or vascular murmurs, symmetrically peripheral arteries pulses. Biological: hyperglycemia, nitrate retention, negative cTnI. ECG: sinus rhythm, LVH with secondary ST-T changes. Echocardiography: Concentric LVH, dilatation of the ascending aorta (41 mm), aortic arch (50 mm), without acute aortic regurgitation. CT scan ruled out our suspicion of acute aortic dissection and showed three aortic aneurysms: aortic arch (59 mm), toraco-abdominal aortic junction (65 mm with 17 mm parietal thrombus) and infrarenal aorta (59 mm). Cerebral MRI excludes vascular or cerebral changes. Results: Final diagnosis: Stage 3 HTN, very high risk group. Aneurysmal dilatations of the aortic arch, thoraco-abdominal aortic junction (complicated with parietal thrombosis), infrarenal aorta. Stage 3 chronic kidney disease. Diabetes mellitus. Conclusions: Therapeutic approach problems: Drug treatment to control BP values associated with surgical treatment of aortic aneurysms versus only BP control using drugs. Under treatment with ACI, beta-blocker, calcium-blocker and diuretic we obtained an optimal mean hypertensive load (2%). Particularity of the case: slightly asymptomatic hypertensive patient with multiple aortic aneurysms complications with surgical indication through serial interventions.