Hypertensive crisis in a middle-aged man with difficult-to-control arterial hypertension: a case report
DOI:
https://doi.org/10.5281/zenodo.21896424Keywords:
hypertensive crisis, treatment-resistant hypertension, headache, hypertensive encephalopathy, case reportAbstract
Introduction: Hypertensive crisis is an acute and severe elevation of blood pressure that threatens vital organs and is a frequent reason for consultation at all levels of health care.
Objective: To describe the case of a patient with a hypertensive crisis and its clinical implications.
Case presentation: We present the case of a 51-year-old man, a heavy long-term smoker, with diabetes mellitus and a history of difficult-to-control arterial hypertension despite three antihypertensive drugs, who sought care for acute intense headache and blurred vision, symptoms that had already occurred sporadically in relation to previous blood pressure elevations. On physical examination he had blood pressure of 210/120 mmHg, mild tachycardia and intense pain, without additional focal findings in the respiratory, cardiovascular or abdominal systems. The working diagnosis was hypertensive crisis, and an electrocardiogram was performed as part of the evaluation for target-organ damage. The available clinical record did not allow reliable documentation of the specific therapeutic regimen administered or of the patient's subsequent course.
Conclusions: This case illustrates the typical clinical presentation of a hypertensive crisis in a patient with difficult-to-control hypertension and multiple concurrent cardiovascular risk factors, and underscores the importance of accurately differentiating hypertensive urgency from emergency, as well as ensuring continuity of antihypertensive treatment after discharge to prevent a new crisis.
References
Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADM, et al. Brazilian Guidelines of Hypertension - 2020. Arq Bras Cardiol. 2021;116(3):516-658. https://doi.org/10.36660/abc.20201238
Vempati R, Alla SSM, Agarwal P, Tarannum S, Ahmed SK, Alla D, et al. Current guidelines in hypertension management with special focus on management of extremely high blood pressure: a systematic review. BMC Cardiovasc Disord. 2025;25. https://doi.org/10.1186/s12872-025-05437-6
Ona DID, Punzalan FE, Oliva RV, Sucaldito MSF, Espallardo N, Santos R, et al. Executive Summary of the 2024 Philippine Clinical Practice Guidelines on the Diagnosis and Management of Acute Severe Blood Pressure Elevation. J Clin Hypertens (Greenwich). 2026. https://doi.org/10.1111/jch.70199
Jenkins S, Mahadevaswamy T, Osman H, Gupta P. Medication non-adherence and apparent treatment-resistant hypertension. Clin Med (Lond). 2026. https://doi.org/10.1016/j.clinme.2026.100566
Fragoulis C, Maloberti A, Boulestreau R, De Backer T, Doumas M, Fucile I, et al. Gaps between guidelines and practice in hypertensive urgencies and emergencies: data from a multinational European registry in ESH excellence centres. J Hypertens. 2026. https://doi.org/10.1097/hjh.0000000000004231
Elbadri A, MohamedSalih E, Mohammedallayla ID, Ikhaiduwor TO, Abdelmalak M, Ali MAM, et al. Management Strategies for Hypertensive Crises: A Systematic Review of Evidence-Based Approaches. Cureus. 2026. https://doi.org/10.7759/cureus.105671
Hochberg CH, Yan L, Card ME, Berry SA, Brodie D, Rotello L, et al. Outcomes of patients with hypertensive emergency managed in intensive vs intermediate care settings: a multihospital retrospective cohort study. Ann Am Thorac Soc. 2026. https://doi.org/10.1093/annalsats/aaoaf048
Prado G, Bea C, Martínez F. Response to the Letter to the Editor: "Hypertensive Urgency: Which Patient will be Fine in a Quiet Room?" J Clin Hypertens (Greenwich). 2026. https://doi.org/10.1111/jch.70293
Choi SY, Choi JH, Choi KD. Hypertensive brainstem encephalopathy with isolated headache and blurred vision: A case report. eNeurologicalSci. 2026. https://doi.org/10.1016/j.ensci.2025.100600
Pierin AMG, Flórido CF, Santos J dos. Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department. Einstein (São Paulo). 2019;17(4):eAO4685. https://doi.org/10.31744/einstein_journal/2019ao4685
Amro AM, Deeb S, Amarneh E, Alboom A, Abuhantash Z, Mustafa M, et al. Cardiovascular disease risk and associated factors among people with hypertension in the West Bank, Palestine. Front Cardiovasc Med. 2026;13:1820592. https://doi.org/10.3389/fcvm.2026.1820592
Estrada GAP, Nico-Garcia M, Akapo OO, Nanjoh MK. Prevalence and Determinants of Uncontrolled Hypertension Among Treated Adults in a Rural Primary Health Care Facility in South Africa: A Cross-Sectional Study. Epidemiologia. 2026;7(3):82. https://doi.org/10.3390/epidemiologia7030082
Han X, Ma W, Wang B, Gu X, Wang G, Lin L, et al. Efficacy and Safety of a Generic Clevidipine in Hypertensive Urgencies and Non-Fulminant Hypertensive Emergencies: A Phase III, Multicenter, Randomized, Double-Blind, Positive Drug Parallel-Controlled Study. J Clin Hypertens (Greenwich). 2025. https://doi.org/10.1111/jch.70144
Han B, Lee GB, Yoon J, Kim YH. Lifestyle interventions for hypertension management in primary care: a narrative review. Exp Med J. 2025. https://doi.org/10.12771/emj.2025.00850
Brown C, Clark D, Jones DW. Updates in the 2025 AHA/ACC Hypertension Guideline. Curr Hypertens Rep. 2026. https://doi.org/10.1007/s11906-026-01372-9
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Copyright (c) 2024 Alef Muniz Leitão, Zara Escobar Benítez (Autor/a)
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