Differential Diagnosis for Hypertensive Crisis
Single Most Likely Diagnosis
- Essential Hypertension: This is the most common cause of hypertensive crisis, often due to non-adherence to medication or inadequate blood pressure control. It is a diagnosis of exclusion, made after ruling out other secondary causes.
Other Likely Diagnoses
- Chronic Kidney Disease: Hypertension can be both a cause and a consequence of kidney disease, leading to a vicious cycle of worsening blood pressure and renal function.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension due to excessive catecholamine release.
- Sleep Apnea: Often associated with obesity, sleep apnea can contribute to resistant hypertension and hypertensive crises.
- Medication Non-adherence or Resistance: Patients may not take their medications as prescribed, or they may develop resistance to the effects of certain antihypertensive drugs.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, potentially leading to aortic rupture. Hypertension is a major risk factor.
- Pulmonary Embolism: Can cause a sudden increase in blood pressure due to the strain on the right heart.
- Intracranial Hemorrhage: Severe hypertension can lead to bleeding in the brain, which is a medical emergency.
- Eclampsia: A condition in pregnant women characterized by new-onset seizures and hypertension, which can be fatal if not promptly treated.
Rare Diagnoses
- Cushing's Syndrome: A rare endocrine disorder caused by excess cortisol, which can lead to hypertension among other symptoms.
- Hyperthyroidism: Excess thyroid hormone can cause an increase in blood pressure.
- Coarctation of the Aorta: A congenital condition where the aorta is narrowed, leading to high blood pressure in the arms and lower blood pressure in the legs.
- Renal Artery Stenosis: Narrowing of the arteries that supply blood to the kidneys, which can cause renovascular hypertension.