Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of resistant hypertension, defined as BP >140/90 mmHg despite adherence to three antihypertensive agents including a diuretic. Reports symptoms potentially suggestive of hypokalemia, including muscle weakness, fatigue, palpitations, and polyuria/nocturia. No history of secondary hypertension causes or recent changes in medication. Family history significant for early-onset hypertension or cerebrovascular events.
Clinical Examination Findings
General: Patient is alert and oriented, in no acute distress. Cardiovascular: Regular rate and rhythm, S1/S2 audible, no murmurs, rubs, or gallops. Peripheral pulses are 2+ and symmetric. No peripheral edema noted. Neurological: Motor strength 5/5 in all extremities, deep tendon reflexes symmetric, no focal deficits. Abdomen: Soft, non-tender, no bruits over renal arteries.
Treatment Protocol
Initiate diagnostic workup with Plasma Aldosterone Concentration (PAC) and Plasma Renin Activity (PRA) ratio. If elevated, proceed to confirmatory testing (e.g., saline suppression test). If confirmed, order adrenal CT imaging to rule out adenoma vs. hyperplasia. Pharmacological management: Initiate Mineralocorticoid Receptor Antagonist (MRA) such as spironolactone or eplerenone. Monitor serum potassium and creatinine levels closely. Surgical consultation for adrenalectomy if unilateral adenoma is confirmed.