A salty cause of severe hypertension

BMJ Case Rep. 2012 Feb 25:2012:bcr1220115336. doi: 10.1136/bcr.12.2011.5336.

Abstract

A 51-year-old lady was referred to our clinic because of severe hypertension; blood pressure 214/119 mm Hg despite treatment with an angiotensin receptor antagonist and a calcium channel blocker. Her initial laboratory results showed hypokalaemic alkalosis with normal urea and creatinine levels. Her 24-h urinary sodium excretion was markedly elevated at 244 mmol (equivalent to a daily intake of approximately 16 g of salt). Hyperaldosteronism was suspected but her plasma aldosterone level was subsequently found to be normal. On further questioning, the patient admitted to eating considerable amounts of salted liquorice and a diagnosis of acquired apparent mineralocorticoid excess was made. Liquorice has a well-known mineralocorticoid activity as it inhibits the action of 11β-hydroxysteroid dehydrogenase 2 and can induce mineralocorticoid hypertension. After stopping eating the salted liquorice, the patient's blood pressure quickly normalised and all her antihypertensive medications were stopped.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Female
  • Glycyrrhiza / adverse effects*
  • Humans
  • Hypertension / etiology*
  • Middle Aged
  • Sodium, Dietary / adverse effects

Substances

  • Sodium, Dietary