FIBROMUSLURAR DYSPLASIA AS A CAUSE OF SECONDARY HYPERTENSION - A CASE REPORT

Objective: A 33-year-old patient came to our clinic for further diagnosis and treatment. Three months earlier she had multiple episodes of high blood pressure (BP) with values rising up to 180/90mmHg which was manifested by headaches, epistaxis and chest pain. In medical history, she has been treated for hyperthyroidism since 2016., on thyrosuppressive therapy until December 2021. She is a smoker, with mild dyslipidemia. Design and method: Initial work up: Physical examination in our Clinic showed no abnormalities. ECG showed sinus rhythm with frequency of 72/min, without changes in the ST segment and T wave. Echocardiography showed normal dimensions of heart cavities and competent valves, without segmental disorders in kinetics with slowed relaxation in diastole and preserved global systolic function. Except microalbuminuria, other laboratory analysis, including functional examination of the adrenal gland, were normal. 24 h BP monitoring showed good BP control with fixed combination therapy (perindopril/amlodipine). Duplex ultrasound (DUS) of renal arteries (RA) showed a decreased resistance index of the intrarenal arteries of the right kidney (0.38), so a suspicion of stenosis of the right RA as a cause of secondary hypertension was raised. Consequently, the computed tomography angiography (CTA) of RAs was done, which showed 80-90% stenosis of right RA in the medial segment with short non-calcified plaque. The vascular board indicated endovascular treatment of the right RA which was done in September 2022. Results: Angiography showed 80% narrowing of the right RA with diffusely irregular edges, which suggested a fibromuscular dysplasia. Procedure led to balloon dilation (according to the guidelines) - NC Accuforce 4.5 x 8 mm balloon was used to inflate stenotic lesion in two levels at up to 12 atm. The final angiographic result was satisfactory. On discharge, patient was prescribed dual antiplatelet therapy, fixed combination perindopril/amlodipine and statin. Conclusions: Every case of hypertension, especially in young, should be thoroughly examined, in order to discover secondary causes. Early diagnosis of fibromuscular dysplasia is essential to prevent possible complications and improve patients quality of life.