Differential Diagnosis for an 84-year-old Patient with BP of 191/112
Single Most Likely Diagnosis
- Hypertensive Crisis: This is the most likely diagnosis given the patient's extremely high blood pressure. Hypertensive crisis can be further divided into hypertensive urgency (where blood pressure is severely elevated but there is no evidence of target organ damage) and hypertensive emergency (where there is evidence of target organ damage). The patient's age and blood pressure reading suggest a potential hypertensive crisis, which requires immediate attention.
Other Likely Diagnoses
- Chronic Hypertension: The patient may have uncontrolled chronic hypertension, which could be contributing to the elevated blood pressure reading.
- White Coat Hypertension: Although less likely given the severity of the reading, the patient could be experiencing white coat hypertension, where the blood pressure is elevated due to anxiety or stress caused by being in a medical setting.
- Medication Non-adherence: The patient may not be taking their prescribed antihypertensive medications as directed, leading to uncontrolled blood pressure.
Do Not Miss Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension. Although unlikely, missing this diagnosis could be catastrophic due to the potential for severe cardiovascular complications.
- Aortic Dissection: A life-threatening condition where there is a tear in the aorta, which can be precipitated by severely elevated blood pressure. Immediate diagnosis and treatment are crucial to prevent fatal outcomes.
- Renal Artery Stenosis: Narrowing of the arteries that supply blood to the kidneys, which can cause secondary hypertension. Missing this diagnosis could lead to progressive renal failure if not addressed.
Rare Diagnoses
- Cushing's Syndrome: A rare endocrine disorder caused by excess cortisol production, which can lead to hypertension among other symptoms.
- Hyperthyroidism: An overactive thyroid gland can cause increased blood pressure, although this would typically be accompanied by other symptoms such as weight loss, palpitations, and heat intolerance.
- Coarctation of the Aorta: A congenital condition where the aorta is narrowed, which can cause high blood pressure. This diagnosis is less likely in an 84-year-old patient but could be considered if there are suggestive symptoms or signs.