A patient has confirmed resistant hypertension on an ACE inhibitor, long-acting calcium-channel blocker and thiazide-like diuretic. Potassium is 3.1

Question

A patient has confirmed resistant hypertension on an ACE inhibitor, long-acting calcium-channel blocker and thiazide-like diuretic. Potassium is 3.1 mEq/L without gastrointestinal losses. Which diagnostic test is most appropriate before imaging?

Accepted Answer

Measure plasma aldosterone and renin to calculate an aldosterone-renin ratio

Answer

Order renal artery CT angiography as the initial endocrine screen

Answer

Begin spironolactone without documenting baseline potassium or renal function

Answer

Perform adrenal venous sampling before biochemical screening

Answer

Measure 24-hour urinary catecholamines because hypokalemia confirms pheochromocytoma

Resistant hypertension — USMLE Step 3 MCQ

A patient has confirmed resistant hypertension on an ACE inhibitor, long-acting calcium-channel blocker and thiazide-like diuretic. Potassium is 3.1 mEq/L without gastrointestinal losses. Which diagnostic test is most appropriate before imaging?