https://doi.org/10.4081/itjm.2021.1419

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

Vol. 15 No. 2 (2021)
Submitted: 5 November 2020
Accepted: 30 December 2020
Published: 2 February 2021
Malignant hypertension, hyperreninemia, multi-organ damage, primary and secondary hypertension.
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Authors

Anna Belfiore
belfiore.murri@gmail.com
https://orcid.org/0000-0003-2534-5753
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Vincenzo Ostilio Palmieri
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Stefania Pugliese
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Maria Ciannarella
https://orcid.org/0000-0002-0682-7688
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Antonella Cezza
https://orcid.org/0000-0002-0836-7507
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
Piero Portincasa
https://orcid.org/0000-0001-5359-1471
Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.

Malignant hypertension is a rare condition characterized by severe hypertension and multi-organ ischemic damage. Marked activation of the renin-angiotensin system is observed in many patients, but its persistence over time is not known. We report a case of a 42-year-old woman who presented with severe hypertension and multi-organ damage. Initial evaluation showed an elevated value of direct renin concentration with normal plasma aldosterone concentration and a nodular lesion in the left adrenal gland. The differential diagnosis between the 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 range. 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.

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How to Cite

Belfiore, A., Palmieri, V. O., Pugliese, S., Ciannarella, M., Cezza, A., & Portincasa, P. . (2021). Malignant hypertension and hyperreninemia: primary or secondary hypertension? A case report. Italian Journal of Medicine, 15(2). https://doi.org/10.4081/itjm.2021.1419
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