Renin profiling for diagnosis, risk assessment, and treatment of hypertension
1993; Elsevier BV; Volume: 44; Issue: 5 Linguagem: Inglês
10.1038/ki.1993.363
ISSN1523-1755
Autores Tópico(s)Heart Failure Treatment and Management
ResumoPatient 1. A 51-year-old physician was referred to The New York Hospital-Cornell Medical Center (NYH-CMC) for refractory hypertension. Two years earlier, a routine physical examination revealed high blood pressure (200/115 mm Hg). He was treated with hydrochlorothiazide, 25 mg daily, but the blood pressure was not reduced, and he became fatigued; the serum potassium was 3.2 mEq/liter. Methyldopa, 250 mg twice daily, and potassium chloride were added to his antihypertensive regimen, but he subsequently complained of increasing lethargy and impotence. At the time of his initial evaluation at the NYH-CMC Cardiovascular Center, the blood pressure was 202/112 mm Hg, the pulse was 68 and regular, and the remainder of the examination was normal. The antihypertensive medications were stopped and all side effects resolved promptly. Laboratory evaluation two weeks later included: normal electrolytes; BUN, 15 mg/dl; serum creatinine, 1.2 mg/dl; cholesterol, 237 mgldl; HDL, 55 mg/dl; and glucose, 88 mg/dl. Urinalysis and electrocardiogram were normal. A 24-hour urine collection contained: sodium, 125 mEq; potassium, 64 mEq; aldosterone, 12 g; and albumin, 48 mg; creatinine clearance was 95 mI/mm. A simultaneous ambulatory plasma renin activity (PRA) was 6.4 ng/ml/hr. The results of the captopril test were: pre-captopril blood pressure, 182/112 mm Hg; pulse, 74 beats/mm; PRA, 4.8 ng/ml/hr; post-captopril: blood pressure, 152/94 mm Hg; pulse, 72 beats/mm; and PRA, 6.8 ng/ml/hr. A captopril renal scan and a renal artenogram were normal. Acebutolol was begun in a dose of 200 mg daily. Within two weeks,
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