ECE2017 Eposter Presentations: Diabetes, Obesity and Metabolism Clinical case reports - Thyroid/Others (16 abstracts)
Resistant hypertension in an obese type 2 diabetic male with obstructive sleep apnea: resolution with CPAP, weight loss and Dulaglutide
Claudia Arnas-Leon 1 , Ana Delia Santana-Suarez 1 , Alba Rodriguez-Perez 2 , Manuel Nivelo-Rivadaneira 1 , Agnieszka Kuzior 1 , Sara Quintana-Arroyo 1 , Carmen Acosta-Calero 1 & Francisco Javier Martinez-Martin 1
1Endocrinology and Nutrition, Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain; 2Internal Medicine, Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain.
A 49-year-old male was referred to our Hypertension Clinic with uncontrolled hypertension, treatment Valsartan/Amlodipine/Hydrochlorothiazide 80/10/25 mg + Doxazosine 4 mg. Mean home BP was 156/103 mmHg. Personal history: dyslipidaemia, central obesity and type 2 diabetes, with mild diabetic retinopathy, persistent microalbuminuria and preserved renal function. Treatment: Metformin/Sitagliptin 1000/50 mg BID; Pravastatin/Fenofibrate 40/160 mg. Height 172 cm, weight 112 kg, BMI 37.8 kg/m2, waist 126 cm, clinic BP 165/99, HR 77; unremarkable physical exam except abdominal adiposity. Glycemia 132 mg/dl, HbA1C 7.2%, Cr 0.92 mg/dl, GFR (CKD-EPI) 97 ml/min per 1.73 m2, Cholesterol 166 mg/dL (HDL 38, LDL 96), Triglycerides 161 mg/dl, Albuminuria 126 mg/g Cr; TSH, Metanephrines, Aldosterone, PRA and ratio were normal. Heart US: normal function, mild LVH (PW and IVW 14 and 13 mm). 24 h. ABPM: Awake BP 157/96, Sleeping 146/89, non-dipper.
The treatment changed to Perindopril/Indapamide 8/2.5 mg, Eplerenone 50 mg and Doxazosine 4 mg. Four months later, the patient had lost 2.5 kg with diet/exercise, but BP and HbA1C had not improved. Dulaglutide 1.5 mg/week was substituted for Sitagliptin. The patient’s wife reported heavy snoring with apparent pauses, and the patient was referred to polysomnography. A severe OSA was diagnosed, and CPAP was initiated.
Six months later, weight was 98.5 kg (IMC 33.1 kg/m2); waist 114 cm, and home and office BP were normal. New ABPM: Awake 132/76, sleeping 116/69, dipper. Glycemia was 114 mg/dl, HbA1C 6,7%, Cr 0.91 mg/dl, GFR 98 ml/min per 1.73 m2, Chol. 153 mg/dl (HDL 43, LDL 79), Trigl. 156 mg/dl, Albuminuria 23 mg/g Cr. New heart US: PW and IVW 11 and 10 mm.
The diagnosis was resistant hypertension with target-organ damage (albuminuria, LVH) associated to OSA, plus type 2 diabetes, central obesity, and dyslipidemia. With CPAP, weight loss and Dulaglutide, BP and glycemic control were achieved and target-organ damage was reversed.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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