open access

Vol 26, No 1 (2022)
Case report
Published online: 2022-03-30
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Drug resistant hypertension and Munchausen syndrome

Malgorzata Wierzowiecka1, Iwona Smolarek2, Karolina Niklas3, Andrzej Tykarski1, Arkadiusz Niklas1
DOI: 10.5603/AH.a2022.0002
·
Arterial Hypertension 2022;26(1):39-44.
Affiliations
  1. Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
  2. Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
  3. Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 26, No 1 (2022)
CASE REPORT
Published online: 2022-03-30

Abstract

A 40-year-old female presented with a history of resistant arterial hypertension associated with massive nasal bleedings. Despite being subjected to a lot of tests in order to identify a cause of secondary hypertension, all possible causes were excluded. There were no organ damages. Notwithstanding changes in the hypotensive treatment regimen and a significant escalation of pharmacological treatment, there were difficulties in achieving normal blood pressure (BP) values. Resistant hypertension was diagnosed. It was decided to perform tests to confirm the patient’s use of hypotensive drugs and to search for substances increasing BP in the Department of Forensic Medicine. High urinary concentrations of pseudoephedrine and its metabolites were found using high-performance liquid chromatography.

During the retrospective analysis of the case of this patient with a psychiatrist, Munchhausen syndrome was suspected.

Abstract

A 40-year-old female presented with a history of resistant arterial hypertension associated with massive nasal bleedings. Despite being subjected to a lot of tests in order to identify a cause of secondary hypertension, all possible causes were excluded. There were no organ damages. Notwithstanding changes in the hypotensive treatment regimen and a significant escalation of pharmacological treatment, there were difficulties in achieving normal blood pressure (BP) values. Resistant hypertension was diagnosed. It was decided to perform tests to confirm the patient’s use of hypotensive drugs and to search for substances increasing BP in the Department of Forensic Medicine. High urinary concentrations of pseudoephedrine and its metabolites were found using high-performance liquid chromatography.

During the retrospective analysis of the case of this patient with a psychiatrist, Munchhausen syndrome was suspected.

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Keywords

resistant hypertension; drug abuse; Munchausen syndrome

About this article
Title

Drug resistant hypertension and Munchausen syndrome

Journal

Arterial Hypertension

Issue

Vol 26, No 1 (2022)

Article type

Case report

Pages

39-44

Published online

2022-03-30

Page views

342

Article views/downloads

55

DOI

10.5603/AH.a2022.0002

Bibliographic record

Arterial Hypertension 2022;26(1):39-44.

Keywords

resistant hypertension
drug abuse
Munchausen syndrome

Authors

Malgorzata Wierzowiecka
Iwona Smolarek
Karolina Niklas
Andrzej Tykarski
Arkadiusz Niklas

References (10)
  1. Murray J. Munchausen Syndrome/Munchausen Syndrome by Proxy. J Psychol. 2010; 131(3): 343–352.
  2. Filho DS, Kanomata E, Feldman R, et al. Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. Einstein (São Paulo). 2017; 15(4): 516–521.
  3. Tatu L, Aybek S, Bogousslavsky J. Munchausen Syndrome and the Wide Spectrum of Factitious Disorders. Front Neurol Neurosci. 2017: 81–86.
  4. Niklas A. Resistant hypertension. In: Gluszek J. ed. Modern therapy of arterial hypertension. Termedia, Poznan 2008: 136–135.
  5. Judd E, Calhoun DA. Apparent and true resistant hypertension: definition, prevalence and outcomes. J Hum Hypertens. 2014; 28(8): 463–468.
  6. Lamirault G, Artifoni M, Daniel M, et al. Resistant Hypertension: Novel Insights. Curr Hypertens Rev. 2020; 16(1): 61–72.
  7. Pessina AC, Bisogni V, Fassina A, et al. Munchausen syndrome: a novel cause of drug-resistant hypertension. J Hypertens. 2013; 31(7): 1473–1476.
  8. Zorzi F, Olivieri O, Pizzolo F. Comment on 'Munchausen syndrome: a novel cause of drug-resistant hypertension'. J Hypertens. 2014; 32(1): 200–201.
  9. Ponte PH, Matas L, Cadafalch J, et al. [Resistant hypertension and no organ damage: A new case of Munchausen syndrome]. Med Clin (Barc). 2016; 146(9): e51–e52.
  10. Spitzer D, Bongartz D, Ittel TH, et al. Simulation of a pheochromocytoma — Munchausen syndrome. Eur J Med Res. 1998; 3(12): 549–553.

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