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

Last updated

Jun 09, 2024

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