A patient is found to have progressively higher blood pressure readings in the first trimester. What is the most likely diagnosis?

In the context of a patient experiencing progressively higher blood pressure readings during the first trimester of pregnancy, the most likely diagnosis is chronic hypertension. Chronic hypertension refers to high blood pressure that is present before pregnancy or that develops within the first 20 weeks of gestation.

In this case, the timing — since the patient is experiencing high blood pressure readings during the first trimester — suggests that the hypertension was already present before the pregnancy or is a continuation of pre-existing conditions. This differentiates it from gestational hypertension, which typically occurs after the 20th week of pregnancy and is not associated with kidney or liver dysfunction or proteinuria.

Preeclampsia is also ruled out because it usually develops later in pregnancy and is characterized by new-onset hypertension and proteinuria or signs of end-organ dysfunction after the 20 weeks of gestation. Acute hypertension is not an established diagnosis on its own in the context of pregnancy and would require a nuanced understanding of the patient's condition. Therefore, chronic hypertension is the correct diagnosis based on the timing of the increased blood pressure readings in the early stages of pregnancy.