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Pediatric hypertension — USMLE Step 3 MCQ

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HardPediatrics (Well-child / Chronic Management)Pediatric hypertensionUSMLE Step 3

A 13-year-old with stage 2 chronic kidney disease has ambulatory-confirmed hypertension and urine protein-creatinine ratio 0.9 mg/mg. Potassium is 4.4 mEq/L. Three months of sodium reduction, weight optimization, and exercise have not normalized blood pressure. Which treatment is most appropriate?

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Reveal the answer and explanation

Correct answer: D — Begin an ACE inhibitor and repeat creatinine, potassium, and ambulatory pressure

The best answer is “Begin an ACE inhibitor and repeat creatinine, potassium, and ambulatory pressure”. Chronic kidney disease with proteinuria is a compelling indication for an ACE inhibitor or ARB in a child with persistent hypertension. Kidney function and potassium are checked after initiation; lifestyle treatment continues but is insufficient alone in this high-risk setting.

Reference: AAP Clinical Practice Guideline for High Blood Pressure in Children and Adolescents: https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and