Introduction:
Secondary hypertension accounts for approximately 5-10% of all cases of hypertension, often suspected in young patients with an acute onset of elevated blood pressure. Drug-induced hypertension represents a smaller subset of secondary hypertension but is becoming increasingly recognized. Oral contraceptives are known to contribute to elevated blood pressure, leading to secondary hypertension in some cases. We present a case of a 19-year-old female who developed secondary hypertension attributed to oral contraceptive use.
Methods:
Case Presentation: A 19-year-old non-obese female was noted to be hypertensive during a neurologist visit for neuropathy and foot drop. She reported a history of hypertension noted at her pediatrician's office, which was previously attributed to white coat hypertension. The highest office blood pressure (BP) recorded was 160/100 mmHg, and a 6-hour ambulatory blood pressure monitoring showed an average BP reading of 139/94 mmHg.
The patient’s family history was notable for early-onset hypertension in her father, diagnosed at the age of 28. She denied any tobacco or alcohol use and had a history of Raynaud’s syndrome. Laboratory workup revealed normal antineutrophil cytoplasmic antibodies (ANCA) and complement levels, with a mild elevation in perinuclear ANCA (P-ANCA) at 1:320. Aldosterone levels were elevated at 110 ng/dL, with a renin level of 2.2 ng/mL/hr. A computed tomography (CT) scan of the abdomen and pelvis showed normal adrenal glands, and plasma-free metanephrines were within the normal range. A renal Doppler ultrasound showed no evidence of renal artery stenosis, and the CT scan did not reveal any adrenal abnormalities. The patient was taking ethinyl estradiol/drospirenone 3-0.03 mg, one tablet orally daily, as an oral contraceptive.
Results:
Given the non-suppressed renin levels and elevated aldosterone, a diagnosis of secondary hyperaldosteronism was made. Her blood pressure and aldosterone levels improved over time with discontinuation of the oral contraceptive.
Conclusions:
This case illustrates the importance of considering drug-induced secondary hypertension in young patients with a sudden onset of elevated blood pressure. Oral contraceptives, such as ethinyl estradiol/drospirenone, can contribute to the development of secondary hyperaldosteronism, leading to hypertension. Discontinuation of the offending agent is crucial in managing such cases. This case underscores the need for careful evaluation of medication history in young patients presenting with hypertension, particularly when other secondary causes are ruled out.
I have no potential conflict of interest to disclose.
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