Objective: Stress is known to contribute to other well-known environmental risk factors to hypertension leading to sympathetic overactivity. While usual environmental factors can be easily measured, exposure to stress is difficult to objectivize, especially during catastrophic events which are recognized as main stressors. There are several reports about earthquakes, blood pressure (BP) and cardiovascular events. Design and method: We are reporting a case on ambulatory blood pressure monitoring (ABPM) in 42-year-old women during Croatian earthquake. Results: A 42-year-old women with multiple genetic and environmental risk factors for hypertension was evaluated for secondary hypertension, and adult autosomal polycystic kidney disease was diagnosed. Kidney function was normal and there were no signs of target organ damage. She was treated with a fixed dose combination perindopril/amlodipine 4/5 mg (morning). ABPM revealed mildly uncontrolled systolic-diastolic hypertension with extreme nocturnal dip. Average 24-hour, daytime and nighttime BP values were 130±20,4/79±19,9 mmHg, 137±16,2 /85±17,9 mmHg, 100±11,8 /55±11,7 mmHg, respectively. White coat effect was present, and masked hypertension was ruled out. Average 24-hour, daytime and nighttime heart rate were: 88b/min, 93b/min, and 79b/min. A significant surge in BP and heart rate (200/130 mmHg,140 b/min) was recorded at 12:30 p.m. exactly at the time when earthquake occurred in city Petrinja, also felt in Zagreb city. The earthquake was clearly stated in the blood pressure diary (Figure 1). Conclusions: Although chronic stress is emphasized to affect human health more than acute, catastrophic events such as earthquakes can have deleterious effect such as enormous elevation of BP. It is necessary to have strategies for BP management in disaster-related diseases to prevent organ damage.