LAUSR

and obstructive sleep apnoea. Current medications included metoprolol 50 mg twice a day, moxonidine 200 µg at night, amlodipine 10 mg daily, indapamide 2.4 mg daily, and irbesartan 300 mg daily. Despite taking five antihypertensives, 24- hour blood pressure monitoring revealed a daytime average of 153/84 mmHg. Plasma aldosterone to renin ratio (ARR) was normal at 43 pmol/mU (reference interval [RI], < 70 pmol/mU; plasma aldosterone 536 pmol/L [RI, 70– 1090 pmol/L]; renin 12.6 mU/L [RI, 4.4– 46 mU/L]), with serum potassium 4.4 mmol/L (RI, 3.5– 5.2 mmol/L) and estimated glomerular filtration rate (eGFR) 47 mL/min/1.73 m 2 To facilitate further investigations, the medications were changed to verapamil sustained release 180 mg daily, prazosin 0.5 mg twice a day, and moxonidine 200 µg at night. Histopathology showing a 5 mm aldosterone- producing micronodule with strong positive staining for aldosterone synthase (CYP11B2 , cytochrome P450 family 11, subfamily B, member 2), a crucial enzyme in aldosterone synthesis