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Severe asymptomatic hypertension — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareSevere asymptomatic hypertensionUSMLE Step 3

A 62-year-old woman is seen for a medication refill. Blood pressure is 184/106 mm Hg in both arms after repeated measurements. She has no chest pain, dyspnea, headache, vision changes, confusion, or neurologic deficits. Creatinine and urinalysis are unchanged from baseline. Funduscopic examination shows no papilledema. Which of the following is the most appropriate at this time?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Start or adjust oral antihypertensive therapy with close outpatient follow-up

Severe asymptomatic hypertension is treated with oral medication adjustment and timely follow-up; rapid parenteral lowering is reserved for hypertensive emergency with acute target-organ injury.

Reference: ACC/AHA hypertension guideline