Refractory hypertension in women controlled after identifying and addressing premenstrual syndrome.

Control of high blood pressure is usually difficult when there is an unidentified cause or there exist certain factors that blunt the effect of appropriate therapy. Premenstrual syndrome (PMS) is neither a known cause of hypertension nor is it listed as one of the factors that blunt effect of antihypertensives. PMS defines a constellation of symptoms confined to the luteal phase of the menstrual cycle interfering with individual function but clears after menstruation in the follicular phase. Though there is no consensus yet on its etiopathogenesis, the various models, inconsistent as they are, can initiate or sustain hypertension. The two patients presented had been frustrated by the attitude of their attending physicians who branded them neurotics and the fact that various drug combinations would not control their blood pressure. The classical recurring nature of their symptoms in relation to the menstrual cycle led to the suspicion of and treatment of PMS. With this, it became easy to control their erstwhile "refractory" hypertension. It is, therefore, recommended that history of PMS be sought and attended to, when premenopausal women without evidence of secondary hypertension have high blood pressures that proove difficult to control.