Does Prolonged Desmopressin Use Cause Refractory Hypertension?

Introduction: Desmopressin treats central diabetes insipidus. Although desmopressin can cause hypertension, this case of refractory hypertension in a patient with central diabetes insipidus is especially intriguing. It also increases cardiovascular risk, particularly with underlying comorbidities. Case Description: The patient is a 49-year-old male who presented to the emergency department with concerns of elevated blood pressure readings at home, despite being treated with amlodipine and losartan at their maximum dosages. His systolic blood pressure (SBP) ranged from 180 to 200 mmHg, while his diastolic blood pressure (DBP) ranged from 100 to 120 mmHg. He has recently commenced monitoring his blood pressure at home and has experienced intermittent occipital headaches for many months. He refutes any additional concerns. He has central diabetes insipidus and has been administering desmopressin for 30 years, in addition to medications for diabetes. He consumes nicotine via vaping, occasionally imbibes alcohol, and smokes cannabis. Underwent septoplasty, uvulopalatopharyngoplasty, and tonsillectomy for obstructive sleep apnea. Developed high blood pressure after being treated for OSA. The patient did not have any additional medical issues. Laboratory results indicated no evidence of hypoxia or renal disease. The EKG revealed T wave inversions in lead III, but troponin levels were not elevated. Head CT did not show any abnormal findings. His systolic blood pressure persisted above 160 mmHg despite the administration of three distinct medications at maximum dosages. Discussion: This case presents a suspicion of chronic desmopressin use resulting in refractory hypertension. While there is uncertainty about preventive strategies, it would be beneficial to implement vigilant monitoring to avert hypertensive crises and life-threatening conditions. Patients taking desmopressin should have their blood pressure closely monitored compared to others, especially if they have other comorbidities such as obesity or diabetes, which increase the risk of cardiovascular disease and stroke. Other non-medical treatments, such as dietary and lifestyle changes, may also help to prevent crises like refractory hypertension.