Importance of Clinical Evaluations Related to Secondary Hypertension in Patients with Resistant Hypertension

Resistant hypertension is defined as poorly controlled status of blood pressure despite of optimal use of three or more antihypertensive drugs of different classes, including diuretics. Although exact prevalence of resistant hypertension is not known, it has been reported to be 12.8% among patients treated with antihypertensive drugs. It is important to evaluate a possible secondary cause in patients with resistant hypertension. We report a case of resistant hypertension with renal artery segmental stenosis that was not revealed in renal Doppler study. Blood pressure of the patient was well controlled after renal balloon angioplasty.

Protective Role of Intercoronary Communication between Right Coronary Artery with Chronic Total Occlusion and Normal Left Circumflex Artery against Recurrent Myocardial Ischemia

Intercoronary communication is a very rare congenital malformation, which differs from coronary collaterals in variable aspects. It is larger in diameter, extramural in location and more resembles normal mature arterial features histologically. There are no consensus for the definition of intercoronary communiations, but some reports have suggested their protective role against myocardial ischemia due to its dual blood supply system. We report the case of a 72 year-old male smoker who had chronic total occlusion at the proximal portion of right coronary artery, which was communicated with a normal left circumflex artery. Although the patient had chronic total occlusion and subsequent in stent restenosis, there were no presentations of acute coronary syndrome or myocardial infarction.