A 48-Year-Old Woman Comes to the Office for Evaluation of Elevated

question 1356

Multiple Choice

A 48-year-old woman comes to the office for evaluation of elevated blood pressure, which was first noted at her dentist's office 4 weeks ago.  Repeated home blood pressure measurements since then have remained around 150/90 mm Hg.  The patient has had no symptoms and has no history of hypertension or other medical conditions.  She takes no medications and does not use tobacco, alcohol, or illicit drugs.  Family history is significant for hypertension in her father.  Blood pressure is 152/88 mm Hg and pulse is 76/min.  A repeat blood pressure measurement after 15 minutes shows a similar reading.  BMI is 28.6 kg/m².  Physical examination reveals clear lungs, normal heart sounds, a nontender abdomen with no organomegaly, and no lower extremity edema.  There are no abnormalities on ECG.  Laboratory testing shows normal serum electrolytes and creatinine and no proteinuria.  Which of the following additional evaluations is most appropriate in this patient?

• A)Assessment of left ventricular function
• B)Home sleep apnea testing
• C)Imaging for renovascular disease
• D)Measurement of plasma renin activity
• E)Screening for diabetes mellitus

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Definitions:

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