PS-R02-1: THE HIDDEN HAND BEHIND AN AORTIC DISSECTION CASE

Abstract

According to the data of WHO, more than 1.1 billion people worldwide suffer from hypertension, which leads to complications such as aortic dissection, acute myocardial infarction, and heart failure seriously threaten human health. Previously, we believed that primary hypertension accounted for 80%-90% of all hypertension, but with the gradual increase in understanding and improvement of detection methods, the understanding of secondary hypertension factors is becoming clearer. Among the secondary hypertension, primary aldosteronism is receiving more and more attention. It is thought that the actual prevalence of primary aldosteronism may account for 30%-50% of hypertension. The dangers of primary aldosteronism are not only in the damage to target organs from blood pressure, but the damage to organs from elevated aldosterone appears much earlier. Early recognition of primary aldosteronism is important to reduce the emergence of complications. We report a case of a patient with aortic dissection with a previous history of thirty years of hypertension, regular medication and stable blood pressure control, who, after a sudden aortic dissection, had laboratory tests suggesting intractable hypokalemia and poor results with potassium supplementation. We further examined aldosterone and renin levels and found that renin levels were significantly lower, with an aldosterone/renin ratio of 72 (reference value: 0–38). Although the patient was not able to standardize medications at the time of examination due to his condition, the ARB, CCB and hydrochlorothiazide medications the patient was on were all elevated for renin. In this case, renin levels remained low and we have reason to believe that the patient could be diagnosed with primary aldosteronism. With this history, we recognize that screening for secondary hypertension is far from adequate, and some scholars believe that less than 1% of hypertensive patients worldwide are currently screened for secondary factors. We believe that screening for secondary hypertensive factors should be performed in all patients with aortic dissection, even whenever there is combined target organ damage in hypertensive patients, regardless of blood pressure values.