Severe hypertension in an adolescent girl.

A 14-year-old girl presented to the emergency department (ED) with pain and swelling in her right foot after a sledding accident. There was no history of head trauma, headaches, nausea, vomiting, vision changes, chest pain or palpitations, abdominal pain, peripheral edema, or sweating. Her initial examination revealed a blood pressure of 204/140 mm Hg, and several repeat blood pressure measurements showed similar results. She had a past history of a positive purified protein derivative test for tuberculosis and asthma, but no exacerbations had occurred during the last 5 years. There was no record of previous blood pressure measurements. She was not taking any prescribed or over-the-counter medications , did not smoke, and denied illicit drug use. Family history was negative for hypertension, end-stage renal disease, early atherosclerotic cardiovascular disease, obesity , diabetes, hyperlipidemia, or familial endocrinopathies.