Intravenous nicardipine for Rx of renovascular hypertension
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Case presentation
A 27-year-old primigravida was admitted to the Department of Cardiovascular Medicine to examine severe hypertension in October 2012. She had a history of hypertension at age 22 and received treatment with antihypertensive medication. However, she did not continue the medication and was lost to follow-up. Doppler ultrasonography revealed bilaterally constricted renal arteries with elevated peak systolic velocities consistent with renal artery stenosis (Figure 1). She was diagnosed with renovascular hypertension possibly due to fibromuscular dysplasia. ECG, chest radiograph, and transthoracic echocardiography were normal. She had normal renal function with a blood urea nitrogen level of 9.5 mg/dl and serum creatinine concentration of 0.53 mg/dl. Plasma renin activity was elevated slightly, at 3.3 ng/ml/h. Percutaneous transluminal angioplasty in conjunction with renal angiography was initially planned, but as she became pregnant, she was referred to our department at 9 weeks of gestation to manage pregnancy under conditions of chronic hypertension. A physical examination revealed a blood pressure of 196/120 mmHg. We gave her a thorough explanation regarding the need of further examination and treatment for hypertension, as well as the possibility of miscarriage. She and her family hoped to continue pregnancy without undergoing angiography and percutaneous transluminal angioplasty given the potential teratogenic effects due to fetal radiation exposure. Therefore, she was started on 750 mg of methyldopa three times daily. Her blood pressure was controlled, transiently going below 150/90 mmHg....
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