A 45-Year-Old Man Comes to the Office Due to Several

question 1665

Multiple Choice

A 45-year-old man comes to the office due to several abnormal blood pressure readings over the past year.  He also has had fatigue, which he attributes to stress at work.  The patient is a carpenter, and his diet consists primarily of fast food several times a day because he is busy with worksite jobs.  He wakes up several times at night and occasionally finds it difficult to fall back asleep.  He has had no chest pain, shortness of breath, light-headedness, or syncope.  Family history is negative for hypertension, stroke, and early-onset coronary artery disease.  The patient drinks 2 beers a day on weekends.  Blood pressure is 151/90 mm Hg on the right arm and 159/95 mm Hg on the left.  Repeat blood pressure on the left arm is 158/94 mm Hg.  Pulse is 78/min and regular.  BMI is 32 kg/m².  Physical examination is unremarkable.  ECG shows normal sinus rhythm with no abnormalities.  Serum chemistry panel and TSH are within normal limits.  Which of the following is the most likely underlying cause of this patient's hypertension?

• A)Alcohol use
• B)Generalized anxiety disorder
• C)Obstructive sleep apnea
• D)Primary hyperaldosteronism
• E)Renovascular disease