Hypertensive Urgency and Pulmonary Infiltrates: A Report of Three Cases
Abstract
Hypertensive urgency is commonly attributed to medication nonadherence, progression of essential hypertension, or secondary causes. However, in some patients, no clear precipitating factor is identified, despite repeated evaluations and the absence of target organ damage. Subclinical inflammatory conditions have been hypothesized as potential, underrecognized contributors to acute blood pressure destabilization. We describe three cases of elderly women with previously diagnosed and treated essential hypertension who presented with episodes of hypertensive urgency without evidence of acute target organ damage. In each case, blood pressure remained persistently elevated despite optimization of oral antihypertensive therapy and exclusion of common secondary causes. Lung ultrasound performed during evaluation revealed pulmonary parenchymal infiltrates suggestive of an inflammatory process, despite minimal or absent respiratory symptoms and unremarkable laboratory tests, electrocardiograms, and chest radiographs. Although microbiological confirmation and inflammatory biomarker elevation were not documented, empirical antibiotic therapy was initiated based on clinical judgment. Follow-up lung ultrasound demonstrated progressive improvement of pulmonary findings, temporally associated with stabilization and improved blood pressure control, allowing simplification or return to baseline antihypertensive regimens. These cases suggest a temporal association between lung…
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