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Hypertensive emergency

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35-year-old male with hypertension, diabetes, hyperlipidemia. The patient was diagnosed with hypertension at 34 years of age and is on losartan and metoprolol and states that he is compliant with his medication including taking his medications today. He states he went to his primary care physician for routine visit and his blood pressure was noted to be elevated of greater than 250 once to the emergency room. The patient otherwise has no symptoms. He states he has been urinating normally with no chest pain, no shortness of breath, no headache, no visual changes, no neurologic symptoms including confusion. In the emergency room, his initial blood pressures 250/159. His creatinine is 6.3. Troponin 0.8 without increasing trend. He denies tobacco or alcohol use. Paternal side has hypertension and diabetes. Echo was normal. Think he’s having hypertension from worsening renal failure?

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