Secondary hypertension should be suspected in patients presenting with resistant hypertension, severe blood pressure elevations, or specific clinical manifestations. Match each patient vignette with the most appropriate initial diagnostic screening test to evaluate the underlying etiology.
- A 35-year-old female presents with frequent pounding headaches, episodic marked tachycardia, and unexplained excessive sweating.Measurement of plasma fractionated free metanephrines
- A 46-year-old male is found to have a blood pressure of 165/100 mm Hg and a serum potassium level of 2.8 mEq/L in the absence of diuretic use.Calculation of the plasma aldosterone concentration to plasma renin activity ratio
- A 71-year-old male with a history of peripheral arterial disease presents with an acute rise in baseline blood pressure and recent episodes of sudden respiratory distress.Duplex Doppler ultrasonography of the renal arteries
- A 38-year-old female presents with progressive weight gain, violaceous abdominal striae, and unexplained osteopenia on a recent dual-energy x-ray absorptiometry scan.Overnight low-dose dexamethasone suppression test
Answer
Pheochromocytoma screens with metanephrines, primary hyperaldosteronism with the aldosterone-to-renin ratio, renal artery stenosis with duplex ultrasonography, and Cushing syndrome with the dexamethasone suppression test.
Secondary hypertension requires targeted testing based on clinical suspicion to avoid unnecessary and expensive diagnostic evaluations. The pairings correctly align each classic clinical presentation with its respective gold-standard initial screening modality as recommended by current clinical guidelines.
Step-by-Step Solution
Key Concept
Screening modalities for secondary causes of hypertension based on specific clinical presentations.