Monday, April 21, 2014
More Than Meets the Eye
You've been seeing a 50 year old patient with resistant hypertension for a while. He was diagnosed several years ago, and you've been slowly increasing his antihypertensives to include hydrochlorothiazide, lisinopril, and amlodipine. Nevertheless, his blood pressures are still consistently 180/100. He has no other significant past medical or surgical problems. He is currently asymptomatic, has no chest pain, shortness of breath, altered mental status, headaches, visual disturbances, edema, or other signs or symptoms.
Laboratory values demonstrate a normal hematocrit, sodium 147, potassium 3.0, chloride 100, bicarb 18, creatinine 1.1, and low plasma renin.
Challenge: What's the diagnosis?
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