Malignant hypertension and hyperreninemia: primary or secondary hypertension? A case report

• Main Authors: Anna Belfiore, Vincenzo Ostilio Palmieri, Stefania Pugliese, Maria Ciannarella, Antonella Cezza, Piero Portincasa
• Format: Article
• Language: English
• Published: PAGEPress Publications 2021-02-01
• Series: Italian Journal of Medicine
• Subjects: Malignant hypertension; hyperreninemia; multi-organ damage; primary and secondary hypertension.
• Online Access: https://www.italjmed.org/index.php/ijm/article/view/1419

Malignant hypertension is a rare condition characterized by severe hypertension and multi-organ ischemic damage. Marked activation of renin-angiotensin system is observed in many patients, but its persistence over time is not known. We report a case of 42-year-old woman presented with severe hypertension and multi-organ damage. Initial evaluation showed elevated value of direct renin concentration with normal plasma aldosterone concentration, and a nodular lesion in the left adrenal gland. The differential diagnosis between primary and secondary form of hypertension had to be questioned. Consequently the patient was followed up for 20 months. Repeated checks showed a significant increase in renin levels with a normal aldosterone concentration and regression of organ damage. After 20 months renin values returned within normal limits. Hyperreninemia persisting over a long period of time has not been fully explained. Long term follow-up allowed us to attribute malignant hypertension to de novo essential hypertension.