Differential Diagnosis for Hypertension

Given a patient with no comorbidities and a blood pressure of 150/90, the following differential diagnoses are considered:

Single Most Likely Diagnosis

• Essential Hypertension: This is the most common cause of hypertension, accounting for about 90-95% of cases. It is a diagnosis of exclusion, made after ruling out secondary causes of hypertension. The patient's age and lack of comorbidities make this a likely diagnosis.

Other Likely Diagnoses

• White Coat Hypertension: This condition is characterized by elevated blood pressure readings in a clinical setting, but normal readings at home. It's possible that the patient's blood pressure is elevated due to anxiety or stress in the medical setting.
• Lifestyle-Related Hypertension: Factors such as a high-sodium diet, physical inactivity, and excessive alcohol consumption can contribute to elevated blood pressure. The patient's lifestyle habits may be contributing to their hypertension.

Do Not Miss Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension. Although unlikely, missing this diagnosis could be catastrophic, as it can lead to severe cardiovascular complications.
• Renal Artery Stenosis: Narrowing of the renal arteries can cause hypertension due to decreased blood flow to the kidneys. This condition can lead to end-stage renal disease if left untreated.
• Hyperthyroidism: An overactive thyroid gland can cause hypertension, among other symptoms. Missing this diagnosis could lead to cardiovascular and other systemic complications.

Rare Diagnoses

• Cushing's Syndrome: A rare endocrine disorder caused by excess cortisol production, which can lead to hypertension.
• Hyperaldosteronism: A rare condition characterized by excess production of aldosterone, a hormone that regulates blood pressure.
• Coarctation of the Aorta: A rare congenital condition characterized by narrowing of the aortic isthmus, which can cause hypertension.

These diagnoses are considered rare but should be kept in mind, especially if the patient's hypertension is resistant to treatment or if other symptoms are present.