A Rare Case of Hypertension

A 61-year-old female was referred to our hypertension centre for uncontrolled hypertension. She had been previously diagnosed with type 2 diabetes mellitus and impaired serum lipid profile. At admission, she assumed β-adrenoceptor antagonists (β-blockers) and calcium antagonists; she had uncontrolled blood pressure levels and she presented with a recent episode of headache associated with syncope and showed negative cerebral CT. Examinations performed in our hypertension outpatient clinic (physical examination, blood biochemistry, instrumental diagnosis and screening for secondary hypertension) had negative outcomes. Average blood pressure on three different determinations was above the normal values. A modification in antihypertensive therapy was performed with no results. During a follow-up visit, the patient lost consciousness. She was promptly transferred to the Cardiac Intensive Care Unit. During the following diagnostic iter (cerebral CT and urinary catecholamine levels based on a 24-hour sample), cerebral MRI evidenced malformation of Arnold Chiari type I. The neurological surgery consultant advised surgical procedure with occipital decompression technique. One year later the patient underwent surgical intervention. The patient actually reports suboptimal control of blood pressure. To date, no episode of transitory coma has occurred.