Step 2

Renal 1

A 54 year old man is being evaluated during an outpatient visit for management of his blood pressure. Medical history is only significant for hypertension and Stage 4 chronic kidney disease with notable proteinuria (≥3.5 g/day). The patient states he is compliant with his current meds which are lisinopril and nifedipine. Patient states he eats a “heart healthy diet”. On exam, BP 152/90, HR 78, RR 18, afebrile and BMI is 29. Neck examination shows jugular venous distension of approximately > 4 cm above the sternal angle. Cardiac examination reveals an S4 that occurs during late diastole. Lungs are clear to auscultation without wheezing or crackles. There is 1+ bilateral pitting edema in the lower extremities. The remainder of the exam is otherwise unremarkable. Recent basic metabolic panel reveals:
Sodium 137
Potassium 5.1
Chloride 94
Bicarbonate 22
BUN 21
Creatinine 2.6
eGFR 25
Glucose 124
Calcium 8.2

Which of the following is the most appropriate additional medical therapy according to the current American College of Cardiology / American Heart Association (ACC/AHA) blood pressure guidelines?

  • A) Chlorthalidone
  • B) Metoprolol Succinate
  • C) Furosemide
  • D) Candesartan
  • E) Hydralazine


Dr. Raj Dasgupta


Dr. Raj Dasgupta

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