“My blood pressure is high”

Chief Complaint

  • 30 year old Caucasian male presents to clinic with high blood pressure


  • 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


  • 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


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?

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