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Polycythemia hypertonica revisited: a metabolic syndrome with high-renin hypertension?

Journal of Human Hypertension volume 36, pages 585–587 (2022)Cite this article

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At the beginning of the 20th century Gaisbock (1905) introduced the term “polycythemia hypertonica” to describe a type of polycythemia, which was seen in middle aged male smokers with obesity, hypertension, and a history of heavy alcohol use. Splenomegaly was absent. The WBC and platelet counts were normal and the incidence of coronary artery disease and stroke was high in these patients. This condition was initially named Gaisbock’s syndrome, but over the following several decades various other terms have been used to define this entity, including stress polycythemia or erythrocytosis, apparent polycythemia, relative polycythemia, pseudopolycythemia, spurious polycythemia, benign polycythemia, and “red face with reduced plasma volume” [1, 2].

The underlying pathophysiologic mechanism had not been defined. Both Osler and Gaisbock indicated that some cases of polycythemia may be related to diminished plasma volume and hemoconcentration rather than a true elevation of red blood cell mass. It had also been emphasized by Gaisbock and others that such patients appeared to have an increased incidence of psychological stress. Indeed, in the early 50’s it was suggested that the psychological stress somehow induces a contraction in plasma volume causing “stress” polycythemia. However, the concept of stress causing sustained polycythemia has not been validate nor generally accepted and other investigators stated that these patients represent the statistical minority beyond two standard deviations of the confidence limits for hemoglobin [3, 4].

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Author notes

  1. Vassilios Vlahakos

    Present address: National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Street, Haidari, Athens, Greece

Authors and Affiliations

  1. National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Street, Haidari, Athens, Greece

    Demetrios Vlahakos

  2. Onassis Cardiac Surgery Center, 356 Sigrou Avenue, 17674, Kalithea, Greece

    Katerina Marathias

  3. Evagelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece

    Vassilios Vlahakos

  4. VA Medical Center and Georgetown University, 50 Irving str NW, Washington, DC, 20422, USA

    Vasilios Papademetriou

Authors
  1. Demetrios Vlahakos
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  2. Katerina Marathias
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  3. Vassilios Vlahakos
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  4. Vasilios Papademetriou
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Contributions

DV: drafted the first draft of the manuscript. KM and VV: contributed to the first and second draft of the manuscript and VP performed critical review and critical revisions of the manuscript.

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Correspondence to Vasilios Papademetriou.

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Vlahakos, D., Marathias, K., Vlahakos, V. et al. Polycythemia hypertonica revisited: a metabolic syndrome with high-renin hypertension?. J Hum Hypertens 36, 585–587 (2022). https://doi.org/10.1038/s41371-021-00620-6

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