Case Presentation: A previously healthy 4-year-old female born in Mexico was sent to the emergency department for elevated blood pressures noted at her routine outpatient clinic visit. On arrival, her blood pressure was 161/126. The patient reported polydipsia, polyuria, and weight loss. Her initial physical exam was unremarkable and her vitals were otherwise within normal [...]

Background: There is no consensus on the management of asymptomatic inpatient hypertension. This is alarming as the prevalence of inpatient hypertension may be as high as 72%. Hypertension treatment guidelines focus on chronic hypertension in the outpatient setting and evidence for inpatient management is lacking. Aggressive treatment of asymptomatic inpatient hypertension with intravenous antihypertensives is [...]

Background: Current guidelines recommend oral (PO) medications as first line therapy for management of hypertensive urgency. However, patients without end-organ damage who are symptomatic or have extremely high blood pressure (BP) may be classified as either “hypertensive urgency” or “emergency” by treating physicians.Objective: In a cohort of hospitalized patients with severe hypertension but no organ [...]

Background: Intravenous (IV) anti-hypertensive medications such as labetalol and hydralazine are commonly administered as needed or “prn” to asymptomatic patients in the hospital with elevated blood pressure. This practice may lead to patient harm (such as hypotension or stroke) and increased costs without any known benefit. Much attention has been focused on this issue in [...]

Case Presentation: A previously healthy sixteen-year old Japanese-American female presented to her primary care provider following one week of frontal headache, dizziness, and a feeling of “floating while walking.” Exam revealed upper extremity blood pressure of 148/93 and a loud bruit across her left lower back. A renal ultrasound ruled out renal artery stenosis, but [...]

Case Presentation: A previously healthy, 7-year-old girl presented to the emergency department with intermittent episodes of achy abdominal and right-sided flank pain for one month. The patient’s mother endorsed pain severe enough to wake the patient from sleep, as well as occasional constipation, and an associated 12-lb weight loss over the previous six months. On [...]

Background: Hypertension occurs in up to 75% of hospitalized patients. However, less than 1% have “hypertensive emergency,” defined as severely elevated blood pressure (BP) with end-organ injury. Current guidelines support emergent treatment of hypertensive emergency but recommend against immediate reduction of severely elevated BP in patients without end-organ injury (i.e., asymptomatic hypertension). Recent literature suggests [...]

Case Presentation: A 54-year-old tracheostomy and gastric tube dependent, non-verbal male with chronic spastic quadriplegia, autonomic dysautonomia, and recent ICU admissions for MDR pneumonia presented to the emergency department from his skilled nursing facility with acute hypertension. His home medications were notable for hydralazine, isosorbide mononitrate, clonidine, midodrine, and an intrathecal baclofen pump. He was [...]