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Stage 2 hypertension diagnosis — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareStage 2 hypertension diagnosisUSMLE Step 3

A 49-year-old man comes for a routine visit. Blood pressure measured with a validated automated cuff is 146/92 mm Hg and 148/90 mm Hg after 5 minutes of rest. He has no symptoms. Home readings over the past month average 144/88 mm Hg. Basic metabolic panel and urinalysis are normal. Ten-year ASCVD risk is 9%. Which of the following is the most appropriate next step in management?

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

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Correct answer: A — Start an antihypertensive medication plus lifestyle modification

Persistent stage 2 hypertension should be treated with lifestyle modification and pharmacotherapy. Secondary hypertension testing is guided by suggestive features such as abrupt onset, resistant hypertension, hypokalemia, or renal bruit.

Reference: 2025 AHA/ACC High Blood Pressure Guideline