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 BOF 56

 

   

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BOF: 56

A 45-year-old male is referred to the hypertension clinic. Control of his blood pressure has been difficult despite use of beta-blockers and ACE inhibitors.

The patient had been told to stay off drugs and when he attended the clinic he was found to have a blood pressure of 190/110

Examination of the fundus showed a grade II retinopathy but other than this examination was unremarkable

Investigations

Sodium 148 mmol /L

Potassium 3.1 mmol/L

Bicarbonate 32 mmol/L

Urea 4.2 mmol /L

Glucose 3.9 mmol/L

In this patient which one of the following would you arrange next?

a)      Aldosterone ratio: plasma renin activity

b)      24 urinary cortisol

c)      High dose dexamethasone suppression test

d)      MR angiogram of renal vessels

e)      PTH assay

 

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