Malignant hypertension and hyperreninemia: Primary or secondary hypertension? A case report

Malignant hypertension is a rare condition characterized by severe hypertension and multi-organ ischemic damage. Marked activation of the renin-angiotensin system is observed in many patients, but its persistence over time is not known. We report a case of a 42-year-old woman who presented with severe hypertension and multi-organ damage. Initial evaluation showed an elevated value of direct renin concentration with normal plasma aldosterone concentration and a nodular lesion in the left adrenal gland. The differential diagnosis between the primary and secondary form of hypertension had to be questioned. Consequently, the patient was followed up for 20 months. Repeated checks showed a significant increase in renin levels with a normal aldosterone concentration and regression of organ damage. After 20 months, renin values returned within normal range. Hyperreninemia persisting over a long period of time has not been fully explained. Long-term follow-up allowed us to attribute malignant hypertension to de novo essential hypertension.