Differential Diagnosis for Hypertension in a 38-year-old Pregnant Woman
- Single most likely diagnosis
- Chronic Hypertension: This is the most likely cause of the patient's hypertension, given that she has not seen a healthcare provider in years and her blood pressure is elevated at the first prenatal visit. The fact that her blood pressure remains elevated after a 15-minute interval suggests that it is not a transient or white coat phenomenon.
- Other Likely diagnoses
- Gestational Hypertension: Although less likely than chronic hypertension, gestational hypertension is a possibility, especially since the patient is at 14 weeks gestation. However, gestational hypertension typically presents after 20 weeks of gestation.
- White Coat Hypertension: Although the repeat measurement was taken 15 minutes later, it is still possible that the patient's hypertension is due to anxiety or stress related to the medical visit.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Preeclampsia: Although the urinalysis is negative for protein, preeclampsia can still be a consideration, especially if the patient's blood pressure is severely elevated or if there are other symptoms such as headaches or visual disturbances.
- Renal Disease: Underlying renal disease, such as chronic kidney disease or glomerulonephritis, can cause hypertension and should be considered, especially if the patient has a history of kidney problems or if the urinalysis shows abnormalities.
- Pheochromocytoma: Although rare, pheochromocytoma can cause severe hypertension and should be considered if the patient has symptoms such as palpitations, headaches, or sweating.
- Rare diagnoses
- Primary Aldosteronism: A rare cause of hypertension due to excess aldosterone production, which can be considered if the patient's blood pressure is resistant to treatment or if there are other symptoms such as hypokalemia.
- Cushing's Syndrome: A rare endocrine disorder that can cause hypertension, which should be considered if the patient has other symptoms such as weight gain, hirsutism, or striae.