UNSTUDIED ARTERIAL HYPERTENSION: A LONG-TERM CATASTROPHE?

Abstract

Arterial hypertension (HTN) is one of the leading modifiable risk factors for cardiovascular and renal disease. Primary aldosteronism (PA) is a treatable cause of secondary hypertension that remains frequently underdiagnosed. Early identification can prevent severe complications. We report the case of a 57-year-old man with long-standing hypertension and poor blood pressure control, admitted for acute heart failure. Notable findings included persistent hypokalemia, chronic kidney disease, and left ventricular hypertrophy. Hormonal evaluation, despite ongoing antihypertensive therapy, revealed markedly elevated plasma aldosterone (1405 ng/dL), suppressed plasma renin activity (0.34 ng/mL/h), and an aldosterone-to-renin ratio >40, confirming the diagnosis of primary aldosteronism. Magnetic resonance imaging showed mild thickening of the left adrenal gland. This case highlights the importance of etiological investigation in resistant hypertension. The diagnosis of primary aldosteronism should be considered in patients with resistant hypertension, hypokalemia, and evidence of target organ damage. A targeted workup—even while maintaining antihypertensive treatment—can lead to accurate diagnosis and may prevent irreversible cardiovascular and renal complications.