MKSAP: 54-year-old man with elevated blood pressure

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications. On this visit and on two subsequent nurse visits, the patient’s blood pressure measurements are less than 140/90 mm Hg. BMI is 34. Cardiac examination reveals an S4 gallop. The remainder of the examination is normal. Laboratory studies show a normal chemistry panel, and a urine dipstick demonstrates no blood or protein. Electrocardiogram demonstrates evidence of left ventricular hypertrophy. Which of the following is the most appropriate next step in management? A. Ambulatory blood pressure monitoring B. Lisinopril C. Plasma aldosterone-plasma renin ratio D. Repeat blood pressure measurement in 6 months MKSAP Answer and Critique The correct answer is A. Ambulatory blood pressure monitoring (ABPM) is appropriate for this patient who likely has masked hypertension. He has evidence of end-organ manifestations (left ventricular hypertrophy) that is potentially related to hypertension, yet has not presented with blood pressure measurements consistent with hypertension (≥140/90 mm Hg). This raises the possibility of masked hypertension, which is defined as normal office blood pressure measurements but elevated blood pressure (>135/85 mm Hg) in the ambulatory setting. Prior to initiating medical therapy, a ...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Cardiology Primary Care Source Type: blogs