PS-R02-5: A CASE OF CONGESTIVE HEART FAILURE DUE TO HYPERTENSION

Abstract

The patient is a 56-year-old man. He was pointed out to have high blood pressure 6 years ago but had not been treated for it. He was hospitalized 4 years ago for heart failure due to atrial fibrillation and underwent catheter ablation therapy. This year, he complained respiratory distress at night and was admitted to the hospital with a diagnosis of congestive heart failure with sinus tachycardia and high blood pressure (height 174 cm, weight 100 kg, blood pressure 178/118 mmHg, pulse 105 bpm). After admission, he was started inhaling oxygen (SpO2 = 97%; nasal oxygen 3L/min) and antihypertensive medications were started with ARNI and calcium channel blocker. His blood pressure decreased, his heart failure improved without the use of diuretics or nitrates, and he no longer required oxygenation. However, because of inadequate pulse control, the calcium channel blocker was changed to beta-blocker, and finally the blood pressure was around 115/80 mmHg and the pulse rate around 85 bpm. At the same time of admission, a close examination of the cause of heart failure was conducted. He smoked 20 cigarettes/day (Ex-smoker from 20 to 35 years old) and still has a drinking habit of 1–2 gou of shochu/day. Blood tests, electrocardiogram, echocardiography, and coronary CT scan were performed to determine that hypertension was the main cause of his heart failure. In order to investigate the involvement of secondary hypertension as a cause of hypertension, examinations including hormone measurements such as catecholamine, aldosterone, renin activity and so on were performed, and a diagnosis of essential hypertension was made. Hypertensive organ damage included hypertensive and arteriosclerotic changes in the fundus and left ventricular hypertrophy. As for cardiovascular disease risk, the patient was male, had a history of non-valvular atrial fibrillation, a smoking history, and moderate Sleep Apnea Syndrome, and belonged to the high-risk group for cerebral cardiovascular disease risk. This patient was able to treat the acute phase of heart failure and maintenance treatment of heart failure only with antihypertensive therapy. The prognosis of hypertensive heart failure is often improved with appropriate antihypertensive treatment.