Treatment of severe hypertension in a 14-year-old child: Successful blood pressure control with additive administration of captopril, an angiotensin-converting enzyme inhibitor, in a patient with bilateral renovascular hypertension.

Abstract

We report a 14-year-old boy with recurrent episodes of headache caused by uncontrolled hypertension. The diagnosis of renovascular hypertension due to Takaysu arteritis (TA) was made based on an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and computed tomography (CT) image of bilateral renal artery stenosis was taken. Renal scintigraphy revealed normal perfusion and function of the right kidney and severe reduction of the perfusion and function of the left kidney. Careful drug adjustments significantly improved but did not fully control the blood pressure (BP); further, angioplasty, which showed almost occlusion of the left renal artery opening and the minor narrowing of the right renal artery, failed to regain sufficient BP control. The addition of captopril, an angiotensin-converting enzyme (ACE) inhibitor, to conventional antihypertensive drugs successfully and safely lowered BP and preserved the renal function. This unique case suggested that ACE inhibitors achieved better control of BP in a patient with bilateral renal stenosis and that the patient may have hemodynamically significant stenosis caused by unilateral renal artery.

• Authors: Xin Zhang, Ying Xu, Xiaoping Chen, Si Wang, Xinran Li, Xin Yan
• Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) (Clin Exp Hypertens) Vol. 39 Issue 7 Pg. 587-591 ( 2017) ISSN: 1525-6006 [Electronic] England
• PMID: 28621587 (Publication Type: Case Reports, Journal Article)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents
• C-Reactive Protein
• Captopril

Topics

• Adolescent
• Angioplasty (methods)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Antihypertensive Agents (administration & dosage)
• Blood Pressure (drug effects)
• C-Reactive Protein (metabolism)
• Captopril (administration & dosage)
• Drug Therapy, Combination
• Hemodynamics (physiology)
• Humans
• Hypertension, Renovascular (drug therapy, physiopathology, surgery)
• Kidney (physiopathology)
• Male
• Recurrence
• Renal Artery (diagnostic imaging)
• Renal Artery Obstruction (complications, diagnostic imaging, surgery)
• Takayasu Arteritis (complications, diagnostic imaging)