This case highlights the extreme difficulty in managing truly resistant hypertension and its fatal consequences despite aggressive medical and surgical intervention.
Refractory hypertension may prove fatal despite nephrectomy and polypharmacy; leaves open the need for novel therapies in extreme cases.
A young man presented with severe hypertension with evidence of both neurological and cardiovascular end-organ damage. Investigation revealed a small right kidney and a left renal artery aneurysm. Significant hypertension persisted even after right nephrectomy. Despite extensive investigation, no evidence was found to implicate the aneurysm in the causation of his high blood pressure. No alternative cause for hypertension was found, yet blood pressure was high even during hospital admission and observed medication dosing with eight antihypertensive agents. Sustained hypertension resulted in worsening left ventricular hypertrophy and he died suddenly at a tragically young age several years after presentation. This gentleman had truly resistant hypertension, a clinical problem which can be very difficult to manage.
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Goodlad et al. (2012) studied this question.
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