Arterial hypertension secondary to polycythemia vera. A case report.

Introduction: Polycythemia vera is a myeloproliferative syndrome that increases the count of the three cell lineages. It is characterized by an increase in erythrocyte mass and is associated with a greater risk of thrombotic events, leukemic transformation and myelofibrosis. Case presentation: A 62-year-old male patient with arterial hypertension being treated with irbesartan, amlodipine, hydrochlorothiazide and bisoprolol, who maintained high blood pressure levels despite aproppiate therapeutic adherence, reported headache, tinnitus, scotomas, tinnitus and vertiginous sensation, besides itching after showering. On physical examination we evidenced high blood pressure, facial redness and splenomegaly. Due to resistant arterial hypertension, spironolactone was added. We order paraclinics who reported elevated hemoglobinemia and to study polyglobulia we ordered a dosage of erythropoietin that was diminished. Given the findings suggestive of polycythemia, we indicated a bone marrow biopsy, whose analysis revealed panmyelosis and a molecular genetic study showed a mutation in JAK2. Based on the above, we define arterial hypertension secondary to polycythemia vera. Cytoreductive treatment with ruxolutinib was ordered and the patient presented a satisfactory evolution accompanied by blood pressure control. Discussion: The prevalence of  Polycythemia vera is 0.68-2.6/100,000 people, with a predominance in males. Diagnosis requires three main criteria (hemoglobin >17.5 in men and >16 gr/dl in women or hematocrit >49% in men and >48% in women, bone marrow biopsy showing panmyelosis or JAK2 mutation) or two criteria main with decreased erythropoietinemia. The typical elevated blood viscosity can increase the burden on the cardiovascular system and impair microvascular endothelial vasodilatory function, events leading to secondary hypertension.