A 28-Year-Old Man Comes to the Office for Follow-Up of Hypertension

question 865

Multiple Choice

A 28-year-old man comes to the office for follow-up of hypertension.  The patient has a 6-month history of fatigue and occasional headaches.  When he came for evaluation 3 weeks ago, his blood pressure was 160/100 mm Hg.  Medical history is unremarkable and he takes no medications.  He has no family history of stroke or early heart disease.  The patient smokes a pack of cigarettes daily but does not use alcohol or illicit drugs.
Blood pressure is 164/102 mm Hg and pulse is 82/min.  BMI is 28 kg/m².  Physical examination is unremarkable.
Laboratory results are as follows:
ECG shows normal sinus rhythm without ischemic changes.  Urinalysis shows 1+ proteinuria.  CT scan of the abdomen reveals normal adrenal glands.
Which of the following is the best next step in management of this patient's disorder?

• A)Adrenal venous sampling
• B)CT angiogram of the renal vessels
• C)Dexamethasone suppression test
• D)Laparoscopy
• E)Treatment with eplerenone

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