Chief Complaint
- 30 year old Caucasian male presents to clinic with high blood pressure
HPI
- Has been treated for hypertension over the past 4 years
- Initially treated with lisinopril to maximal dose, then chlorthalidone was added at maximal dose with minimal response
- Ambulatory blood pressures averaging 150s/90s
- Denies chest pain, shortness of breath, dizziness, lightheadedness, visual changes, changes in urination, headaches, or palpitations
PMH
- Hypertension, currently on Lisinopril 40 mg daily, chlorthalidone 100 mg daily
- Asthma well-controlled on Albuterol as-needed
Family History
- Father with hypertension, diagnosed in his 50s
Social History
- No smoking or illicit drug use
- Social alcohol consumption
Vitals
Temp: 37.1° C, BP: 162/92 mmHg, HR: 85 bpm, RR: 14 rpm, SpO2: 95% on room air, BMI: 27
Physical Exam
- No thyroid goiter or abnormalities appreciated
- Heart rate normal in rate and rhythm without murmurs
- Abdomen soft, nontender
- No appreciable abdominal or carotid bruit
What’s on your differential diagnosis?
What would you do next in the work-up for this patient?
Home 