Hypertensive Urgency and Pulmonary Infiltrates: A Report of Three Cases

Hypertensive urgency is commonly attributed to medication nonadherence, progression of essential hypertension, or secondary causes. However, in some patients, no clear precipitating factor is identified, despite repeated evaluations and the absence of target organ damage. Subclinical inflammatory conditions have been hypothesized as potential, underrecognized contributors to acute blood pressure destabilization. We describe three cases of elderly women with previously diagnosed and treated essential hypertension who presented with episodes of hypertensive urgency without evidence of acute target organ damage. In each case, blood pressure remained persistently elevated despite optimization of oral antihypertensive therapy and exclusion of common secondary causes. Lung ultrasound performed during evaluation revealed pulmonary parenchymal infiltrates suggestive of an inflammatory process, despite minimal or absent respiratory symptoms and unremarkable laboratory tests, electrocardiograms, and chest radiographs. Although microbiological confirmation and inflammatory biomarker elevation were not documented, empirical antibiotic therapy was initiated based on clinical judgment. Follow-up lung ultrasound demonstrated progressive improvement of pulmonary findings, temporally associated with stabilization and improved blood pressure control, allowing simplification or return to baseline antihypertensive regimens. These cases suggest a temporal association between lung ultrasound-detected pulmonary infiltrates and hypertensive urgency in patients with essential hypertension. While causality cannot be established, subclinical inflammatory pulmonary processes may represent potential contributors to acute blood pressure elevation in some patients. Lung ultrasound may serve as a useful adjunctive tool in the evaluation of unexplained hypertensive urgency. Prospective studies incorporating microbiological and inflammatory markers are needed to further clarify this possible association.