Research Article
Volume 7 Issue 3 - 2020
Resistant Hypertension: Don’t Forget Subclinical Hypothyroidism
Salem Bouomrani1,2* and Alatraa Ben Khalifa1,2
1Department of Internal Medicine, Military Hospital of Gabes, Gabes, Tunisia
2Sfax Faculty of Medicine, University of Sfax, Sfax, Tunisia
*Corresponding Author: Salem Bouomrani, Department of Internal Medicine, Military Hospital of Gabes, Gabes, Tunisia.
Received: January 27, 2020; Published: February 26, 2020


Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction with a prevalence of 10% but remains under diagnosed and often neglected in primary care. Among all specific cardiovascular manifestations associated to SCH, hypertension remains unusual and too controversial. Severe hypertension due to SCH is exceptional. It can be the first manifestation of the thyroid dysfunction representing a real diagnostic and therapeutic challenge for clinicians. We report an original observation of severe and resistant hypertension revealing SCH in 38-year-old Tunisian man.

Keywords: Hypertension; Subclinical Hypothyroidism; Cardiovascular Involvement; Hypothyroidism; Resistant Hypertension


  1. Chaker L., et al. “Hypothyroidism”. Lancet 390.10101 (2017): 1550-1562. 
  2. Baumgartner C., et al. “Subclinical hypothyroidism: summary of evidence in 2014”. Swiss Medical Weekly 144 (2014): w14058. 
  3. Garmendia Madariaga A., et al. “The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis”. Journal of Clinical Endocrinology and Metabolism 99.3 (2014): 923-931. 
  4. Chen YJ., et al. “Diagnosis of unrecognized primary overt hypothyroidism in the ED”. American Journal of Emergency Medicine 28.8 (2010): 866-870.
  5. Mitchell JM. “Thyroid disease in the emergency department. Thyroid function tests and hypothyroidism and myxedema coma”. Emergency Medicine Clinics of North America 7.4 (1989): 885-902.
  6. Chaker L., et al. “Hypothyroidism and hypertension: fact or myth? - Authors' reply”. Lancet 391.10115 (2018): 30. 
  7. Charles L., et al. “Secondary Hypertension: Discovering the Underlying Cause”. American Family Physician 96.7 (2017): 453-461.
  8. Renna NF. “Resistant hypertension: An update”. Hipertensión y Riesgo Vascular 36.1 (2019): 44-52. 
  9. Judd E and Calhoun DA. “Apparent and true resistant hypertension: definition, prevalence and outcomes”. Journal of Human Hypertension 28.8 (2014): 463-468. 
  10. Gonzalez Gil L and de la Sierra A. “Prevalence of hypertension and other cardiovascular risk factors in subjects with subclinical hypothyroidism”. Medicina Clínica 148.8 (2017): 351-353.
  11. Berta E., et al. “Hypertension in Thyroid Disorders”. Frontiers in Endocrinology 10 (2019): 482.
  12. Piantanida E., et al. “Masked hypertension in newly diagnosed hypothyroidism: a pilot study”. Journal of Endocrinological Investigation 39.10 (2016): 1131-1138. 
  13. Polat Canbolat I., et al. “Evaluation of Daily Blood Pressure Alteration in Subclinical Hypothyroidism”. Acta Cardiologica Sinica 33.5 (2017): 489-494.
  14. Nath M., et al. “Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism”. Diabetes and Metabolic Syndrome 11.2 (2017): S997-S1000. 
  15. Hofstetter L and Messerli FH. “Hypothyroidism and hypertension: fact or myth?” Lancet 391.10115 (2018): 29-30.
  16. Handler J. “Hypertensive emergency with cardiac tamponade associated with hypothyroidism”. Journal of Clincial Hypertension 9.1 (2007): 67-72.
  17. Dey A., et al. “A study of the cardiac risk factors emerging out of subclinical hypothyroidism”. Journal of Family Medicine and Primary Care 8.7 (2019): 2439-2444. 
Citation: Salem Bouomrani and Alatraa Ben Khalifa. “Resistant Hypertension: Don’t Forget Subclinical Hypothyroidism”. EC Cardiology 7.3 (2020): 01-03.

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