A 27-Year-Old Man Comes to the Physician for Follow-Up of Hypertension

question 956

Multiple Choice

A 27-year-old man comes to the physician for follow-up of hypertension.  He feels healthy and has no complaints.  Two weeks ago, he was found to have high blood pressure during an emergency department visit for a sports injury.  The patient has a strong family history of hypertension and stroke.  His blood pressure is 155/97 mm Hg and pulse is 78/min.  Physical examination and basic laboratory workup are unremarkable.  He is instructed to follow a low-salt diet and started on low-dose (12.5 mg daily) hydrochlorothiazide.  Two weeks later, the patient comes to the emergency department complaining of muscle cramps, weakness, and palpitations.  His blood pressure is 150/93 mm Hg and pulse is 82/min.  Mucous membranes are moist.  Laboratory results are as follows: Which of the following is the best next step in management of this patient?

• A)Computed tomography angiography of the abdomen
• B)Dexamethasone suppression test
• C)Plasma renin activity and aldosterone concentration
• D)Serum thiazide level
• E)Urine potassium excretion by 24-hour collection

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