One Cause of Secondary Hypertension

A 37-year-old woman was referred to us with a 20-year history of hypertension. She was examined by cardiologists for secondary hypertension. Results from blood tests including renin-angiotensin-aldosterone system and catecholamine were normal, and computed tomography of the abdomen was also normal. Her blood pressure (BP) was 190/120 mm Hg despite combination therapy with amlodipine 10 mg, olmesartan 40 mg, doxazosin 4 mg, diltiazem 100 mg, spironolactone 25 mg, indapamide 2 mg, bisoprolol 5 mg, and guanabenz 4 mg. MRI of the brain showed that the left vertebral artery (VA) was obviously compressing the left medulla oblongata (Figure C), and a presumptive diagnosis of refractory neurogenic hypertension was made. To ensure our diagnosis, an angiographic examination was performed for preoperative evaluation under direct measurement of arterial pressure. Angiography showed marked contortion of the left VA to …