A 52-year-old woman is evaluated in the outpatient clinic for persistently elevated blood pressure. Over the past six months, her blood pressure has remained uncontrolled despite reported adherence to a regimen of amlodipine, lisinopril, and chlorthalidone. She complains of generalized weakness, intermittent muscle cramps in her calves, and mild fatigue. Her medical history includes osteoarthritis, seasonal allergic rhinitis, and mild, chronic dyspepsia. She has no prior surgeries. She does not smoke or drink alcohol, follows a standard diet, and walks 30 minutes daily. Her current prescription medications include her antihypertensives, and she frequently takes over-the-counter pain relievers and oral decongestants. Her temperature is 37.0°C (98.6°F), blood pressure is 168/98 mm Hg, and pulse is 76/min. Physical examination reveals no peripheral edema, abdominal bruits, or abnormal facies.
Laboratory studies show:
| Laboratory Study | Result | Reference Range |
|---|---|---|
| Serum sodium | 145 mEq/L | 136-145 mEq/L |
| Serum potassium | 2.7 mEq/L | 3.5-5.0 mEq/L |
| Serum chloride | 101 mEq/L | 98-106 mEq/L |
| Serum bicarbonate | 31 mEq/L | 22-28 mEq/L |
| Plasma renin activity | 0.1 ng/mL/hr | 0.6-4.3 ng/mL/hr |
| Serum aldosterone | 1.5 ng/dL | 4.0-21.0 ng/dL |
Further targeted history-gathering regarding which of the following areas is most critical to establishing the diagnosis in this patient?
- Consumption of specific botanical supplements or traditional confectionsCevap
- BFrequency and cumulative dosage of over-the-counter analgesic agents
- CConcurrent use of over-the-counter sympathomimetic cold preparations
- DHistory of sudden-onset, severe headaches accompanied by palpitations
- EAdherence to recommended dietary sodium restriction and aerobic exercise guidelines