Antihypertensives

Abstract

Lack of efficacy: case reportA 66-year-old woman exhibited lack of efficacy during treatment with nifedipine, azilsartan, carvedilol, furosemide, trichlormethiazide and spironolactone for hypertension.The woman, who had hypertension, had been receiving daily treatment with nifedipine 40mg, carvedilol 20mg, azilsartan 20mg, furosemide 20mg, trichlormethiazide 2mg and spironolactone 20mg [routes and frequencies not stated]. However, the hypertension was refractory to the treatment. Therefore, she presented to a hospital. Examinations revealed atrophic left kidney with a peak systolic velocity. A CT scan revealed equivalent enhancement and severely stenosed renal arteries with advanced calcified ostium of bilateral kidneys.The woman received unspecified treatment. After 10 months of the treatment, she was admitted in another hospital due to palpitation with a markedly elevated BP of 264/96mm Hg. She received nicardipine to prevent fatal haemorrhagic events, her BP immediately reduced. However, her urination and renal function worsened rapidly. Due to anuria, haemodialysis was initiated. She was suspected with acute renal failure due to renal arterial stenosis. Examinations revealed atherosclerotic renal artery stenosis. She underwent percutaneous transluminal renal artery angioplasty (PTRA) to the right renal artery stenosis. Renal stent was successfully deployed. Following the procedure, her urinary volume was increased dramatically and dialysis was discontinued. Her BP decreased to about 130mm Hg and she was taking fewer antihypertensive drugs than prior to the admission. Later, she was discharged. Her BP was stabilised.