Step 2

Renal 2

67-year-old woman with a history of achalasia (successfully treated with a Heller myotomy with partial fundoplication) and osteoporosis, currently being treated with a yearly IV infusion of zoledronic acid, is noted to have an elevated blood pressure reading during her current health care maintenance visit. The patient is doing well and is without symptoms or complaints. The patient is a retired registered nurse and states that in the past 6 months, two blood pressure measurements done in the health care setting averaged above 150/90 mm Hg. However, during that same time period, blood pressure measurements obtained at home averaged less than 130/80 mm Hg. She has no other pertinent personal, social or family history. She takes no other medications besides calcium and Vit D supplements. On exam today she has the following vitals:

  • BMI 19
  • BP 150/92
  • HR 70
  • RR 14
  • O2 sat 98% on RA
  • afebrile

The remainder of the physical examination, including ophthalmic exam, is normal.

Which of the following is the most appropriate management for this patient?

  • A) Begin hydrochlorothiazide
  • B) Obtain a basic metabolic panel and start lisinopril
  • C) Collect 24-hour urine metanephrines and catecholamines
  • D) Perform ambulatory blood pressure monitoring
  • E) Order a magnetic resonance angiography (MRA) of the renal arteries


Dr. Raj Dasgupta


Dr. Raj Dasgupta

Last updated

Jun 09, 2024

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