Paroxysmal hypertension in a 48-year-old woman

Abstract

CASE PRESENTATION A 48-year-old woman was referred for a second opinion regarding paroxysmal hypertension. At the time of referral, she had an 18-month history of acute hypertensive crisis necessitating hospitalization. She had already undergone evaluation by primary care and endocrinology prior to this presentation. Prior to 18 months ago, she had no history of hypertension and her past medical history was only significant for two previous pregnancies, neither of which was accompanied by hypertension. She described herself as healthy and exercised daily prior to onset of these hypertensive attacks. She generally felt well rested. She saw her primary care physician regularly for health care maintenance and reported that her blood pressure prior to 18 months ago usually ranged from 110 to 120 mm Hg systolic, with a heart rate of 60–70 beats per minute. She had no family history of hypertension. She was divorced and had two children. She did not smoke, drank one to two cups of coffee per day, drank three to four glasses of wine in the evenings, denied illicit drug use, and had no known drug allergies. At the time of our initial evaluation, she was taking atenolol 25 mg daily as prescribed by her primary care physician. She denied use of non-steroidal anti-inflammatory drugs, vitamins, herbals, or other over the counter medications.