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Reminder of important clinical lesson
A salty cause of severe hypertension
  1. Elena Sanchez Ruiz-Granados1,
  2. Genevieve Shouls1,
  3. Christine Sainsbury1,
  4. Tarek Antonios2
  1. 1Blood Pressure Unit and Department of Clinical Sciences, St George’s, University of London, London, UK
  2. 2Cardiovascular Sciences Department, St George’s Hospital, University of London, London, UK
  1. Correspondence to Dr Tarek Antonios, tarek.antonios{at}


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.

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  • Competing interests None.

  • Patient consent Obtained.

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