An Uncommon Presentation of Hypertensive Emergency in a Young Patient: A Case Report

A hypertensive emergency is defined as severe blood pressure elevation with acute end-organ damage, carrying significant morbidity and mortality. We describe a 25-year-old male with no prior medical history of hypertension who presented with painless hematuria, epistaxis, mild headache, and unilateral upper extremity paresthesia. Initial blood pressure was 253/167 mmHg. The patient's workup was notable for evidence of acute kidney injury, hematuria, and rising troponins. Electrocardiogram demonstrated ST elevations in aVR and V1-V3, with diffuse ST depressions. Computed tomography (CT) scans were negative for aortic dissection and intracranial pathology. Given evidence of end-organ damage, he was diagnosed with hypertensive emergency and treated with intravenous labetalol followed by nicardipine infusion, targeting a 20-25% reduction in blood pressure. Further evaluation revealed hypertensive retinopathy and renal thrombotic microangiopathy on biopsy. Workup for secondary causes was pursued, and he was transitioned to multidrug oral antihypertensive therapy with subsequent blood pressure control and outpatient follow-up. In conclusion, this case highlights an uncommon presentation of hypertensive emergency in a young patient without prior history of hypertension. It emphasizes the importance of recognizing end-organ damage rather than focusing solely on numeric blood pressure values.