Refractory hypertension in young-beware of substance abusers!

摘要

A 34-year-old man became first symptomatic with features of anxiety neurosis about 10 years back (2001). Six months later he was noted to have elevated blood pressure (BP) 160-220/ 90-130mmHg). At the same time he also noted episodic headaches, palpitations, and giddiness. He was started on antihyper-tensives but required four drugs to control his BP. Complete evaluation for secondary hypertension failed to reveal any cause. Since April 2009, his BP was uncontrolled with four drugs and multiple alterations were made in his treatment. At one point of time he was receiving seven antihypertensives in maximal doses (prazosin, propranolol, enalapril, losartan, aliskiren, clo-nidine, and methyldopa) with persistent wide excursions of BP (140-280/100-180 mrnHg). In May 2009, he developed redness of eye. Evaluation by an ophthalmologist was suggestive of keratoconjunctivitis. This was resistant to all forms of treatment offered (antibacterial, antifungal, antiviral, and immunomodu-lators). He was referred to this centre for further evaluation.He complained of headache, palpitations, and giddiness which had increased in frequency and duration. He had persistent tremulousness. Detailed history did not point to any specific cause but probability of pheochromocytoma was kept high. His eye symptoms persisted on medications. There was no family history of hypertension.