Differential Diagnosis for High Blood Pressure with Back Pain
Single Most Likely Diagnosis
- Hypertensive Crisis: This condition is characterized by severely high blood pressure that can lead to organ damage. Back pain can be a symptom due to the potential for kidney involvement or aortic dissection, although the latter is more of a "do not miss" diagnosis. The high blood pressure itself can cause symptoms, and back pain might be related to the stress the condition puts on the body.
Other Likely Diagnoses
- Chronic Kidney Disease (CKD): High blood pressure is both a cause and a consequence of CKD. Back pain can be associated with CKD due to possible kidney enlargement or cysts in conditions like polycystic kidney disease.
- Pyelonephritis: An infection of the kidney, which can cause back pain (flank pain) and may lead to or exacerbate high blood pressure due to the body's response to infection.
- Nephrolithiasis (Kidney Stones): While not directly causing high blood pressure, the severe back pain associated with kidney stones can lead to elevated blood pressure readings due to pain-induced stress.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where there is a tear in the aorta's inner layer. It can cause severe back pain and is associated with high blood pressure. Missing this diagnosis can be fatal.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of high blood pressure, along with back pain if the tumor presses on surrounding structures.
- Renal Artery Stenosis: Narrowing of the arteries that supply blood to the kidneys, which can cause high blood pressure and potentially back pain due to ischemic nephropathy.
Rare Diagnoses
- Primary Aldosteronism: A condition where the adrenal glands produce too much aldosterone, leading to high blood pressure. Back pain is not a primary symptom but could be related to secondary effects like kidney stones.
- Cushing's Syndrome: A hormonal disorder caused by prolonged exposure to high levels of cortisol. It can lead to high blood pressure and, less commonly, back pain due to osteoporosis or vertebral fractures.
- Vasculitis (e.g., Takayasu Arteritis): Inflammation of the blood vessels that can cause high blood pressure and back pain due to aortic or renal artery involvement.