A 50-year-old man with a history of hypertension, type 2 diabetes with neuropathy, hyperlipidemia, paroxysmal atrial fibrillation, congestive heart failure, and chronic kidney disease stage 3 presented to the emergency room with chest pain, shortness of breath, and hypertension. His systolic blood pressure readings were greater than 220 mmHg. On exam, the patient was alert and oriented.