Question of the Week # 383

383)  A 38 year old african-american male nurse is evaluated in your office because his blood pressure was found to be elevated when the doctor Employee Health Center checked his blood pressure. He was checked in the Employee Health 3 months ago and at that time, his blood pressure was 146/94 mm Hg and a repeat reading by the same doctor was 148/92 mm Hg  a month ago. He checked his blood pressure at home two times at his home and it was ranging between 120/76 to 124/82.  He does not trust this doctor at his work place so, he decided to come and visit you. He denies any dizziness, chest pain, palpitations or shortness of breath. He does not smoke or does not drink alcohol. Several members in family have history of Hypertension. On examination, his blood pressure is 150/94.  His Body Mass Index is 26kg/m2. Cardiac examination shows regular heart sounds. There are no audible murmurs. An electrocardiogram reveals positive voltage criteria for left ventricular hypertrophy. A subsequent 2D-Echo reveals left ventricular hypertrophy with good ejection fraction at 60% and no valvular problems.  Serum creatinine is 1.0mg% and Urinalysis is normal. A lipid profile has been ordered. Which of the following  is the most appropriate investigation to be ordered next?

A) Exercise Stress Test

B) Ambulatory Blood Pressure Monitoring

C) Hemoglobin A1C

D) Plasma Metanephrines

E) Captopril Renal Scan

6 Responses

  1. B)ABPM to r/o white coat hypertension

  2. C) Hemoglobin A1C -Insulin resistance is a risk factor for Essential Hypertension.

    EKG with positive voltage criteria for LVH,Echo showing LVH ,3 BP readings > 140/90 on 3 separate occasions,
    risk factors such as family h/o and African America ethnicity and absence of symptoms of Sec Htn like renal bruit (not E),dizziness, chest pain, palpitations or shortness of breath (not D) all give the diagnosis of Essential Hypertension

    The lower BP ranges on a home glucose monitor is probably an error.

    • I meant home BP monitor

  3. b

  4. B

  5. c

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