A 64-year-old female presents with a blood pressure of 200/118. What is the most likely diagnosis?

The most likely diagnosis in this scenario is hypertensive crisis, which is characterized by extremely elevated blood pressure levels, typically defined as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 120 mmHg. In this case, the patient presents with a blood pressure of 200/118, which clearly falls within these parameters.

Hypertensive crisis can be subcategorized into two types: hypertensive urgency and hypertensive emergency. The distinction is based on the presence or absence of target organ damage. While the specific details regarding target organ damage are not provided in the scenario, the severity of the blood pressure reading alone categorizes this case as a hypertensive crisis.

Both acute hypertensive episode and moderate hypertension do not accurately represent the severity of the blood pressure readings here. An acute hypertensive episode generally suggests a sudden increase but may not necessarily reach the levels that define a crisis. Moderate hypertension indicates a sustained, elevated blood pressure but does not encompass the critical nature of the current readings.

In summary, the extreme blood pressure measurement of 200/118 indicates a hypertensive crisis, making it the most appropriate diagnosis in this context.