A 56-year-old woman presents for elevated blood pressure, which was noted at a job-site screening. She has gained 20 lb (9.1 kg) during the past 5 years and takes naproxen sodium (at a dose of 220 mg daily) for joint pain. She has never smoked, and she consumes one or two alcoholic drinks daily. Both of her parents received a diagnosis of hypertension in their 50s. On examination, the blood pressure is 162/94 mm Hg in both arms while the patient is seated and 150/96 mm Hg while the patient is standing. The body-mass index (the weight in kilograms divided by the square of the height in meters) is 29. Her examination is notable only for abdominal obesity without bruits or masses. The serum level of sodium is 138 mmol per liter, potassium 3.8 mmol per liter, calcium 9.4 mg per deciliter (2.35 mmol per liter), fasting glucose 105 mg per deciliter (5.8 mmol per liter), and creatinine 0.8 mg per deciliter (71 μmol per liter). Urinalysis is negative. How would you further evaluate and treat this patient?.
ASJC Scopus subject areas