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Hypertension with albuminuria — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareHypertension with albuminuriaUSMLE Step 3

A patient has persistent hypertension, type 2 diabetes and albumin-to-creatinine ratio 180 mg/g. eGFR is preserved, potassium is 4.4 mEq/L and there is no prior ACE-inhibitor intolerance. Which initial antihypertensive strategy best provides kidney protection?

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Correct answer: D — Start ACE inhibition and recheck creatinine and potassium

The best answer is “Start ACE inhibition and recheck creatinine and potassium”. Diabetes, hypertension, and albuminuria make ACE inhibition kidney protective by lowering intraglomerular pressure and albuminuria. Check renal function and potassium after initiation. Metoprolol, aspirin, renal-artery angiography, or deferring treatment do not provide the indicated renoprotective antihypertensive strategy.

Reference: AHA/ACC, High Blood Pressure Guideline: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000249