Approach to hypertension Quiz: Ace Your Exams

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A 55-year-old man with a past medical history of essential hypertension for 10 years presents to the clinic for follow-up. The patient’s blood pressure has been consistently elevated despite being on a thiazide diuretic, a calcium channel blocker, and an angiotensin-converting enzyme inhibitor. He reports medication compliance and adherence to a low sodium diet. He does not use tobacco, alcohol, or other recreational drugs. BMI is 23 kg/m2. Temperature is 36.7°C (98.1°F), blood pressure is 156/96 mmHg, heart rate is 85/min, respiratory rate is 16/min, and oxygen saturation is 98% on room air. Physical examination reveals a well-nourished male in no distress. Cardiovascular examination is normal without evidence of heart failure. No abdominal bruits are heard. Laboratory results are shown below. Which of the following findings is most likely to be seen on this patient's evaluation?  

Laboratory value  
Result
Hemoglobin
14.1 g/dL  
Leukocyte count  
6,500/mm3  
Platelet count  
350,000/mm3  
Sodium
147 mEq/L  
Potassium
2.9 mEq/L  
Chloride
97 mEq/L  
Bicarbonate  
31 mEq/L  
Creatinine
1.0 mg/dL  

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