Conclusions

This case illustrates that a hypertensive emergency can present in young adults without a prior history of hypertension, reinforcing the need for emergency physicians to maintain a high index of suspicion when multisystem symptoms accompany severely elevated blood pressure. Clinical decision-making should prioritize the identification of end-organ damage over reliance on numeric blood pressure. Early recognition, appropriate blood pressure management with a target reduction of 25% in the first hour, and prompt evaluation for secondary causes of hypertension are essential to improving outcomes in this patient population.