Secondary Hypertension and Essential Thrombocythaemia

Abstract

A 26-year-old man visited the Outpatient Hypertension Unit, Department of Internal Medicine, University of Pisa, Italy, for uncontrolled hypertension under a two-drug antihypertensive treatment. He had been previously diagnosed with essential thrombocythaemia and had been prescribed aspirin (acetylsalicylic acid) 100 mg/day since he was 20 years old, with a stable platelet count of about 700 000–800 000. High blood pressure lasted 3 months and was treated with lisinopril 20 mg/day. One month before the visit he had an acute coronary syndrome, with normal coronary angiogram, and clopidogrel 75 mg/day and amlodipine 5 mg/day were added at discharge. At the Hypertension Unit, a bilateral renal artery stenosis was diagnosed, accompanied by cardiac and renal target organ damage. Moreover, a total occlusion of the right carotid artery was found. The patient underwent bilateral percutaneous renal angioplasty with stent placement. He was discharged with interferon-α-2b, aspirin and warfarin and with no antihypertensive therapy, having blood pressure values of 100/70 mmHg. A few months later he became hypertensive again and lisinopril 20 mg/day was prescribed, while platelet count was reduced to 500 000. Nine months later he died of a sudden death.