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Successful long-term effects of direct renin inhibitor aliskiren in a patient with atherosclerotic renovascular hypertension

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Abstract

A 64-year-old man visited our hospital with complaints of misty vision and ophthalmalgia. On admission, his blood pressure (BP) was high at 220/135 mmHg with no past history of hypertension, and he had choked discs. He was tentatively diagnosed as having idiopathic intracranial hypertension, and was later found to have atherosclerotic unilateral renovascular hypertension (RVH) based upon the extremely high plasma renin activity together with the radiological image tests. On day 3, combined antihypertensive therapies consisting of oral angiotensin II receptor blocker (ARB) and Ca channel blocker (CCB) along with intravenous CCB induced an abrupt BP lowering which led to deterioration of his renal function, progressing into acute kidney injury (AKI). Cessation of the ARB and reduction of the CCB dose ameliorated the AKI-related decline in renal function. On day 17, as he was reluctant to receive surgical intervention, he was treated with a direct renin inhibitor, aliskiren, combined with a half-dose CCB as a maintenance antihypertensive therapy. The therapy has proven not only successful to chronically maintain his renal function but was also capable of controlling his BP in the neighborhood of 130/85 mmHg over a period of 2 years. The present case suggests that the direct renin inhibition with aliskiren can be a safe and useful antihypertensive option to control hypertension and to preserve renal function in patients with atherosclerotic unilateral RVH.

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Acknowledgements

A part of this case report was presented at the 4th Annual Scientific Forum of Clinical Hypertension of the Japanese Society of Hypertension held in Fukuoka, May 2015.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Norihiko Morisawa, Naoki Sugano, Takafumi Yamakawa, Satoru Kuriyama & Takashi Yokoo

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  1. Norihiko Morisawa
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  2. Naoki Sugano
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  3. Takafumi Yamakawa
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  4. Satoru Kuriyama
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  5. Takashi Yokoo
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Corresponding author

Correspondence to Norihiko Morisawa.

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No conflict of interest is declared.

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Informed consent for using aliskiren and case reporting was obtained from the patient.

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This article does not contain any studies with human participants performed by any of the authors.

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Morisawa, N., Sugano, N., Yamakawa, T. et al. Successful long-term effects of direct renin inhibitor aliskiren in a patient with atherosclerotic renovascular hypertension. CEN Case Rep 6, 66–73 (2017). https://doi.org/10.1007/s13730-016-0246-x

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  • DOI: https://doi.org/10.1007/s13730-016-0246-x

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