MEDizzy - A 25-year-old black man presents to your office seeking to

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HYPERTENSION

A 25-year-old black man presents to your office seeking to establish primary care. The patient has no complaints and denies any known medical history. His blood pressure is noted to be 185/115; otherwise, his physical examination is normal. After measuring the patient's blood pressure a total of four times during two office visits, you diagnose hypertension. Which of the following statements regarding the initial evaluation of hypertension in this patient is true?

ExplanationThe correct answer is A. Secondary hypertension may be suspected on finding features that are not consistent with essential hypertension. Such features include age at onset younger than 30 years or older than 50 years; blood pressure higher than 180/110 mm Hg at diagnosis; significant target-organ injury at diagnosis; hemorrhages and exudates on fundus examination; renal insufficiency; LVH; poor response to appropriate three-drug therapy; and accelerated or malignant hypertension. The clinician should inquire about a family history of hypertension, premature CV disease, and disorders that would increase the possibility of secondary hypertension. The examination should include at least two standardized measurements of blood pressure with the patient in the seated position. Initially, blood pressure should also be measured in the opposite arm (to identify arterial narrowing, which can cause an inaccurately low reading in one arm) and in the standing position, especially in diabetic patients and older patients (to identify orthostatic declines). Retinal examination should be performed, primarily to identify retinal changes of diabetes or severe hypertension (i.e. hemorrhages, exudates, or papilledema).