Resistant hypertension in 40 yo female. Struggling for 6 years now
Hi. I’m writing to get advice on my sister struggling with resistant hypertension. We’ve been working on this since 2020 and been through 4-5 doctors now.
Age: 40 years, female
Problem list: Sjogrens disease (not currently taking anything for it, no real symptoms right now), hashimotos disease (newly treated), resistant hypertension, chronic headaches
Highest numbers we usually get: 190/115, 200/115
Current meds: amlodipine 2.5 BID (not to exceed 5 mg), losartan 100 mg, HCTZ 25 mg, Levothyroxine 75 mcg
Nothing else notable. Has a mirena IUD for the last several years. Not overweight. Diet is fine. Leads a busy life with 4 kids and full time work.
Tests ran (in 2020) when we first learned of the problem:
-Normal renal arteries (checked my MRA with and without contrast)
-Aldosterone was 16,
-Plasma renin activity was 0.15
-Aldosterone/PRA ratio was 107
-At the time, no evidence for hypokalemia
-No evidence of renal nodules
At the most she was doing 4 meds (toprol, HCTZ, hydralazine, valsartan) and it was still off and on controlled. Missing even one tablet would shoot it back up. Since then we’ve switched out some meds for others like losartan, etc.
Eventually was referred to an endocrinologist after it wasn’t responding to 4 meds. This is what the endocrinologist wrote in her progress note:
Although her PRA was suppressed, her aldosterone was only 9.7. She is not hypokalemic, even on a
thiazide diuretic. Her catecholamines and cortisol were normal. Her CT scan did not show any adrenal abnormalities. Therefore, the most likely explanation for the low renin is a medication effect from her beta blocker, and not an endocrine cause such as an aldosteronoma or adrenal hyperplasia.
Since then we’ve been bouncing between specialists trying to find the right cocktail for her. For awhile, a clonidine patch was working well (strangely the pill wasn’t but the patch worked better). Sometimes things just stop working and we have to tinker again. Currently she’s doing losartan, HCTZ, and amlodipine. She was found to have a TSH of 55 recently and they put her on Levothyroxine 75 mcg. Doing that and tinkering with her meds again help a little. Some days it’s still high.
What could this be? What am I missing? What do we need to do? I’m in the medical field (though NAD) and have been trying to help advocate for her but it is exhausting. I don’t know what to ask for. We’ve tried all the meds…is it really just finding whatever cocktail works for the moment? Why can’t we figure out what is actually causing this?
ETA: we live in Southern California if anyone has any advice. We tried a physician at Loma Linda, Hoag, Saddleback and now with a cardiologist in Tustin, CA that specializes in hypertension research.