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Difficult-to-control secondary hypertension in a patient with history of glioblastoma, and cerebral edema — a case study
Affiliations- Department of Internal Diseases with Hypertension Unit, Copernicus Municipal Hospital, Gdańsk, Poland
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
open access
Abstract
We report a history of a patient with difficult-to-control high blood pressure, central nervous system mass and several comorbidities which altogether made the blood-lowering medication particularly challenging. Patient was diagnosed with glioblastoma, renovascular stenosis to a single kidney, and cerebral edema resulting from both cerebral tissue mass and exceedingly high systemic blood pressure. In the presented case we faced several contraindications to the guideline-recommended treatment with RAAS blockers, beta-blockers, and several diuretic classes which were determined by (1) the only remaining kidney’s renal artery stenosis, (2) decreased creatinine clearance and (3) reflex bradycardia secondary to cerebral edema. Evidence-based recommendations do not clarify all clinical aspects related to emergent high blood pressure because the evidence is sparse; therefore, we found it interesting to share our experience.
Abstract
We report a history of a patient with difficult-to-control high blood pressure, central nervous system mass and several comorbidities which altogether made the blood-lowering medication particularly challenging. Patient was diagnosed with glioblastoma, renovascular stenosis to a single kidney, and cerebral edema resulting from both cerebral tissue mass and exceedingly high systemic blood pressure. In the presented case we faced several contraindications to the guideline-recommended treatment with RAAS blockers, beta-blockers, and several diuretic classes which were determined by (1) the only remaining kidney’s renal artery stenosis, (2) decreased creatinine clearance and (3) reflex bradycardia secondary to cerebral edema. Evidence-based recommendations do not clarify all clinical aspects related to emergent high blood pressure because the evidence is sparse; therefore, we found it interesting to share our experience.
Keywords
secondary hypertension; renovascular hypertension; chronic kidney disease; cerebral edema; glioblastoma; hypertensive encephalopathy; hypertension emergencies
About this articleTitle
Difficult-to-control secondary hypertension in a patient with history of glioblastoma, and cerebral edema — a case study
Journal
Issue
Article type
Case report
Pages
88-91
Published online
2021-05-18
Page views
567
Article views/downloads
517
DOI
Bibliographic record
Arterial Hypertension 2021;25(2):88-91.
Keywords
secondary hypertension
renovascular hypertension
chronic kidney disease
cerebral edema
glioblastoma
hypertensive encephalopathy
hypertension emergencies
Authors
Małgorzata Placek
Marta Sołtysiak
Jacek Drozdowski
Jacek Wolf
References (19)- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018; 39(33): 3021–3104.
- Tykarski A, Filipiak K, Januszewicz A, et al. 2019 Guidelines for the Management of Hypertension — Part 1–7. Arterial Hypertension. 2019; 23(2): 41–87.
- Wytyczne Grupy Ekspertów Sekcji Chorób Naczyniowych Polskiego Towarzystwa Neurologicznego. Pol J Neurol Neurosurg. 2012; 46(Suppl. 1).
- Wiśniewski K, Bryl M, Bobeff EJ, et al. Ciśnienie śródczaszkowe a mózgowy przepływ krwi. Pol Przegl Neurol. 2017; 14(2): 57–62.
- Moss E. The cerebral circulation. BJA CEPD Rev. 2001; 1(3): 67–71.
- Oppenheimer BS. Hypertensive encephalopath. Arch Int Med. 1928; 41(2): 264.
- Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000; 356(9227): 411–417.
- Stott VL, Hurrell MA, Anderson TJ. Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J. 2005; 35(2): 83–90.
- Striano P, Striano S, Tortora F, et al. Clinical spectrum and critical care management of posterior reversible encecphalopathy syndrome (PRES). Med Sci Monit. 2005; 11: 549–553.
- Vora J, Cooper J, Thomas JP. Polyarteritis nodosa presenting with hypertensive encephalopathy. Br J Clin Pract. 1992; 46(2): 144–145.
- Schärer K, Benninger C, Heimann A, et al. Involvement of the central nervous system in renal hypertension. Eur J Pediatr. 1993; 152(1): 59–63.
- Garg RK. Posterior leukoencephalopathy syndrome. Postgrad Med J. 2001; 77(903): 24–28.
- Truwit CL, Denaro CP, Lake JR, et al. MR imaging of reversible cyclosporin A-induced neurotoxicity. AJNR Am J Neuroradiol. 1991; 12(4): 651–659.
- Ito Y, Niwa H, Iida T, et al. Post-transfusion reversible posterior leukoencephalopathy syndrome with cerebral vasoconstriction. Neurology. 1997; 49(4): 1174–1175.
- Tajima Y, Isonishi K, Kashiwaba T, et al. Two similar cases of encephalopathy, possibly a reversible posterior leukoencephalopathy syndrome: serial findings of magnetic resonance imaging, SPECT and angiography. Intern Med. 1999; 38(1): 54–58.
- McCullough PA. B-type natriuretic peptides. A diagnostic breakthrough in heart failure. Minerva Cardioangiol. 2003; 51(2): 121–129.
- Bunevicius A, Deltuva V, Laws ER, et al. Preoperative N-terminal pro-B-type natriuretic peptide concertation and prognosis of brain tumor patients: a 5-year follow up study. Sci Rep. 2017; 7(1): 14775.
- Vickery S, Price CP, John RI, et al. B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis. 2005; 46(4): 610–620.
- Maraghi SEl, Yahia H, Heikal A, et al. B-type natriuretic peptide in hypertensive crises: Diagnostic use in hypertensive urgencies and emergencies. Egypt J Crit Care Med. 2013; 1(2): 61–67.