The Rational Clinical Examination
David L. Simel, Drummond Rennie
David L. Simel, Lori Orlando
abdominal bruit, hypertension, renal artery stenosis
"A 55-year-old, white, male smoker has had hypertension for 10
years. It has always been well controlled, with systolic measures
of lower than 35 mm Hg. He is receiving a diuretic and a -blocker.
Recently, the systolic pressure has typically been 140 to 150 mm
Hg. He is a bit overweight (body mass index, 26.5). There has been
no evidence for atherosclerotic disease. His serum creatinine level
is unchanged, at 0.11 mol/L. The serum
cholesterol level is 5.95 mmol/L. Your suspicion is that
the increased blood pressure is a manifestation of essential hypertension,
but you decide to auscultate for an abdominal bruit. You hear none.
You would like to add an angiotensin-converting enzyme inhibitor,
but you wonder whether you have ruled out renal artery stenosis
as a cause of the recent upward trend in his pressure...."
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