Secondary Hypertension and Essential Thrombocythaemia

Abstract

A 26-year-old man visited the Outpatient , for uncontrolled hypertension under a two-drug antihypertensive treatment. He had been previously diagnosed with essential thrombocythaemia and had been prescribed aspirin (acetylsalicylic acid) 100 mg day since he was 20 years old, with a stable platelet count of about 700 000-800 000. High blood pressure lasted 3 months and was treated with lisinopril 20 mg day. One month before the visit he had an acute coronary syndrome, with normal coronary angiogram, and clopidogrel 75 mg day and amlodipine 5 mg day were added at discharge. At the Hypertension Unit, a bilateral renal artery stenosis was diagnosed, accompanied by cardiac and renal target organ damage. Moreover, a total occlusion of the right carotid artery was found. The patient underwent bilateral percutaneous renal angioplasty with stent placement. He was discharged with interferon-a-2b, aspirin and warfarin and with no antihypertensive therapy, having blood pressure values of 100 70 mmHg. A few months later he became hypertensive again and lisinopril 20 mg day was prescribed, while platelet count was reduced to 500 000. Nine months later he died of a sudden death.