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Abstract: SA-PO765

The Clinical Conundrum of Secondary Hypertension in Young Adults: A Case of Extreme Renin Elevation Associated With Coarctation of the Aorta

Session Information

  • Hypertension and CVD: Mechanisms
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

  • 1503 Hypertension and CVD: Mechanisms

Authors

  • Gupta, Rohit Kumar, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Taber-Hight, Elizabeth, Indiana University School of Medicine, Indianapolis, Indiana, United States
Introduction

Hypertension may affect 1 in 8 young adults between 20-40 years of age. In the year 2000, worldwide prevalence of hypertension was estimated as 12.7% in men and 7.4% in women between 20-29 years of age and 18.4% in men and 12.6% in women between 30-39 years of age. Uncontrolled hypertension at a young age is associated with complications such as cardiovascular disease, cerebrovascular accidents and increased mortality that persist into late adulthood. This underscores the need to evaluate hypertension, including secondary causes, in young adults.

Case Description

A 27 year-old woman was referred to our clinic for hypertension. She was diagnosed with hypertension at the age of 10. Her hypertension was well controlled with medications (including azilsartan and metoprolol), but no previous work up for secondary hypertension was available. Labs revealed elevated plasma renin of 11300 pg/ml, normal serum aldosterone of 11.5 ng/dl and an aldosterone-to-renin ratio of <0.1. Contrasted computed tomography (CT) revealed severe coarctation of the aorta (COA) with minimal patent lumen. No renin-secreting tumor or renal artery stenosis was identified. Severe COA was confirmed by invasive aortography.

Discussion

This case describes an association between severe COA, extreme plasma renin elevation and hypertension. The mechanism behind renin elevation in this situation is unclear. In addition to severe COA with minimal patent lumen and elevated pressure gradients across the coarcted segment identified by CT angiography and invasive aortography, findings such as “dampened upstroke” by renal arterial doppler and moderately-to-severely reduced ankle-brachial indices suggest that renal hypoperfusion may play a role. Use of the angiotensin II receptor blocker azilsartan to control hypertension likely contributed to some degree of plasma renin elevation and relatively suppressed serum aldosterone. It is also notable that plasma renin remained extremely elevated despite concomitant use of metoprolol. Hypertension was reasonably controlled medically, but the patient ultimately underwent coarctation repair of hemodynamically significant, severe COA.