Unexplained hypertension in a previously normotensive dialysis patient

(Section Editor: M. G. Zeier) A 1957 born male patient, who was dialysis dependent since 1976, was normotensive until March 1998. Due to the longstanding chronic haemodialysis therapy and persisting hepatitis B, the patient was much concerned about his long‐term survival. The patient carefully controlled his blood pressure and reached his prescribed dry weight after each of his 5‐h dialysis sessions. Echocardiography revealed normal septum and posterior wall thickness (11 mm) and normal size of the left atrium and inferior vena cava. He was a fulltime employee and had no major complications during the previous 10 years, apart from carpal tunnel operation and parathyroidectomy due to secondary hyperparathyroidism. In mid‐March the patient developed a rapid deterioration of his blood pressure. He was admitted to the renal unit twice because of episodes of marked blood pressure increase (above 200 mmHg). During these hypertensive episodes he experienced severe anxiety, palpitations and tachycardia. Due to his longstanding dialysis course and intermittent mental instability, his reaction to the hypertensive episodes was underestimated by attending physicians.