A 37-year-old gravida 5, para 2-0-2-2 patient was referred to the emergency department at 11 weeks’ gestation when she was incidentally found to be in hypertensive crisis during a routine prenatal visit.
Her obstetric history was significant for gestational hypertension in her first pregnancy and preeclampsia in her second pregnancy. After the delivery of her second child, she was diagnosed with essential hypertension by her primary care physician. Despite multiple medications, her blood pressure was difficult to control.
Her medical and surgical histories were otherwise unremarkable. Her family history was notable for hypertension in her father and younger brother. Her brother’s hypertension was also refractory to multiple medications.
On arrival at the emergency department, the patient’s blood pressure was 239/114 mm Hg. She received intravenous (IV) antihypertensives and was admitted to a cardiac intensive care unit. She underwent cardiac evaluation with a normal transthoracic echocardiogram, troponin levels, and electrocardiogram. Treatment...