Abstract Body: Resistant hypertension is defined as blood pressure that remains elevated despite adherence to a regimen of three or more antihypertensive agents of different classes. It represents a significant risk factor for cardiovascular disease, chronic kidney disease, and increased mortality. We describe a challenging case of a 33-year-old male with resistant hypertension, complicated by severe left ventricular hypertrophy and hypertensive nephrosclerosis progressing to end-stage renal disease (ESRD). Comprehensive evaluation for secondary causes of hypertension was unrevealing, including renal artery stenosis, primary hyperaldosteronism, Cushing’s syndrome, pheochromocytoma, aortic coarctation, and hyperparathyroidism. Cardiac catheterization showed no evidence of coronary artery disease, and hemodynamic assessment ruled out high-output heart failure. Despite aggressive pharmacologic management with nine different classes of antihypertensives, including a calcium channel blocker, alpha-2 adrenergic agonist, beta-blocker, angiotensin II receptor blocker, alpha-1 blocker, loop diuretic, aldosterone antagonist, and two direct vasodilators, the patient’s blood pressure remains poorly controlled. The patient is currently undergoing evaluation for renal transplantation.
This case highlights the clinical challenges and therapeutic limitations in managing resistant hypertension, particularly in young patients with progressive target organ damage. We also explore emerging and adjunctive treatment strategies and discuss considerations for renal transplant eligibility and outcomes in this population.