ECE2020 Audio ePoster Presentations Adrenal and Cardiovascular Endocrinology (121 abstracts)
Paradoxical hypertension: The hidden risk of beta blockade
Alba Hernández Lázaro 1 , Ana Falcon-Suarez 2 , Valeria Gazzaneo 3 , Paula Maria Fernandez-Trujillo-Comenge 1 , Agnieszka Kuzior 1 , Manuel Esteban Nivelo-Rivadeneira 1 , Ana Delia Santana-Suarez 1 , Carmen Acosta-Calero 4 , Claudia Arnas-Leon 4 & Francisco Javier Martinez-Martin 5
1Hospital Dr Negrín, Endocrinology, Las Palmas de GC, Spain; 2Centro de Salud Escaleritas, Las Palmas de GC, Spain; 3Consultorio Local, Bañaderos, Consultorio Local, Bañaderos, Arucas, Spain; 4Hospital San Roque, Endocrinology, Las Palmas de GC, Spain; 5Hospital Dr Negrín, Outpatient Hypertension Clinic, Las Palmas de GC, Spain
Introduction: Betablockers are not a first-line antihypertensive therapy, although they have specific cardiological indications. The use of betablockers, especially the non-selective ones, may be associated with paradoxical hypertension, due to unopposed alpha-adrenergic peripheral vasoconstriction.
Methods: Review of the patient’s Clinical Record and of the relevant literature.
Results: Clinical Case: A 66 year old woman was referred to our Outpatient Hypertension Clinic for evaluation of severe hypertension. She had no known allergies, did not smoke, her plasma glucose andlipid profile were normal, had underwent surgery of varicose veins in both legs. Her treatment included calcium plus vitamin D for osteopenia and alprazolam for anxiety (she was the main caretaker of her husband who had severe cognitive impairment). She did not take SSRI or MAO inhibitors. In the last two years she complained of uncontrolled hypertension in spite of multiple treatments, weight loss of about 3 kg, anxiety, tachycardia and tremor. She had consulted a private cardiologist, who ordered a transthoracic echocardiogram and a 24 hour ABPM. Both were reported as normal and she was prescribed propanolol. With this treatment she hads severe hypertensive episodes with SBP up to 250 mmHg with holocraneal headache, with pallor and nausea. Her blood pressure in our clinic was 136/81 mmHg, heart rate 77 bpm, her body mass index was normal and the physicalexamination was unremarkable. Lab tests (including plasma aldosterone and renin) were normal except for very high plasma normetanephrine (481.2 pg/ml, range 18–111) and slightly elevated metanephrine (64.9 pg/ml, range 12–60) The presuntive diagnosis is phaeochromocytoma/paraganglioma, as plasma normetanephrine was very high and the paradoxical hypertensive response to propanolol is characteristic. Abdominal CT and MIBG gammagraphy have been ordered and treatment with doxazosine has been instaured.
Conclusion: Betablockers should not be used in patients with uncontrolled hypertension in the absence of specific cardiological indication, until phaeochromocytoma/paraganglioma is ruled out. In the absence of alpha blockade, beta blockade may trigger severe hypertensive crisis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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