SAT-354 A Rare Case Of Idiopathic Hypertensive Crisis Presenting With Record High Blood Pressure

Abstract A. Ahmed: None. M. Mortagy: None. A. Ghaffar: None. Introduction: The highest pressure recorded in literature is 370/360. We present an interesting case of hypertensive crisis with record high blood pressure. Case presentation: This is a 51-year-old white man with no past medical history who presented to the emergency department (ED) with intermittent blurred vision for the last 3 years as a referral by his ophthalmology because of bilateral papilledema and retinal haemorrhages. He denies headaches, vertigo, sensory loss, focal weakness, chest pain, dyspnea, abdominal pain, hematuria, bowel changes, leg edema, back pain, and constitutional symptoms. He denies any medications or herbal use. The patient was afebrile with normal heart rate, respiratory rate, and oxygen saturation. His blood pressure was unrecorded using digital or manual machines. Arterial line showed blood pressure (BP) to be 341/146. He was alert, oriented. He didn’t have clinical features of endocrine disease. Neurological, heart, chest and abdominal examination were unremarkable. He had no lower limb edema or jugular venous distention.Full blood count, serum sodium, potassium, CRP and liver function tests were normal. Creatinine was 1.1 mg/dl. Thyroid function tests, am cortisol and serum metanephrines were unremarkable. Urine dip was unremarkable. Urine protein creatinine ratio was mildly elevated. ECG showed sinus rhythm, non-specific T wave changes and no ventricular hypertrophy. CXR, CT head, thoracic aorta and adrenals were unremarkable. U/S kidney showed left lower pole cortical scaring.He was given oral modified release (MR) Nifidepine 20 mg. BP improved to 225/125. He was discharged home on nifedipine 20 mg MR, indapamide 2.5 mg, and spironolactone 25 mg. BP improved to be 140/110 after 1 week. Discussion: It is difficult to categorize this patient into hypertensive emergency or urgency. He had evidence of end organ damage (retina and kidney). However, these are most likely chronic changes as his symptoms lasted 3 years and his blood pressure was record high to the point it would cause severe symptoms if was acute. That’s why the patient was managed successfully as hypertensive urgency with oral agents only without needing IV agents. No underlying cause has been found. Conclusion: It is difficult at time to categorize patients into hypertensive emergency or urgency. It is important to lower high BP acutely without putting the patient at risk for strokes. Saturday, June 1, 2024