PS-C27-4: CONTROLLED RESISTANT HYPERTENSION FOLLOWING A SUCCESSFUL RENAL ARTERY STENTING: A RARE CASE REPORT IN A DEVELOPING COUNTRY

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Introduction: Renal artery stenosis is among the etiologies of secondary hypertension in which the diagnosis and therapy are difficult. We report a case of a patient suffered from uncontrollable hypertension with frequent episode of malignant hypertension, treated with renal artery stenting. Case Description: A 36-year-old female visited cardiovascular policlinic on a routine control for her hypertension. Having diagnosed with hypertension for two years, he had several episodes of malignant hypertension. At the beginning of her treatment, she was prescribed an angiotensin-converting-enzyme inhibitor yet her pressure was not only uncontrolled but also worsen. By the visit, she was medicated using two alpha-2-adrenergic agonists, a loop diuretic, a beta-blocker, a calcium-channel blocker, an angiotensin-receptor blocker, and an aldosterone-receptor antagonist without any satisfactory outcome on her blood pressure status. She had a blood pressure of 196/130 mmHg with tachycardia of 112 times/minute. We found cardiomegaly on physical examination which proven by chest x-ray. Echocardiography indicated hypertensive heart disease. Screening for secondary hypertension, including laboratory tests (complete blood count, potassium, sodium, creatinine, fasting glucose, fasting lipid profile, urinalysis, thyroid stimulating hormone, 24H urinary free cortisol) suggested normal results. Renal ultrasound and doppler were also conducted and showed a suspicion of right renal artery stenosis. Therefore, angiography of the renal artery was conducted for diagnostic and therapy when indicated. The angiography suggested a normal left renal artery while the right artery had a 95% stenosis on the proximal part. An intravascular ultrasound-guided percutaneous transluminal angioplasty on her right renal artery was conducted and two vascular stents were implanted. The patient showed a remarkable development following her decreasing blood pressure on follow-up. After 1 week, her blood pressure is now controllable on a single antihypertensive and antiplatelet therapy. Conclusion: The diagnosis and management of a patient with resistant hypertension might be challenging, particularly in the setting of a developing country. Renal artery angiography, among other examination, might be crucial in the diagnosis sequence, yet was not always readily available. We present a case in which diagnosis of renal artery stenosis was made followed by a definite treatment resulting in a remarkable hypertension control. An identifiable etiology is the key to a proper and the best treatment option for the patient.