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A 58-year-old man is evaluated for resistant hypertension. He was first diagnosed with hypertension 10 years ago, and his blood pressure has been increasingly difficult to control. Testing for secondary causes of hypertension will be undertaken.

Medical history is otherwise unremarkable. Current medications include lisinopril, spironolactone, hydrochlorothiazide, and metoprolol.

On physical examination:
- Blood pressure: 149/93 mm Hg
- Other vital signs: Normal
- BMI: 29
- The remainder of the physical examination is unremarkable.

Which of the following should be discontinued prior to screening for secondary causes of hypertension?

A. Hydrochlorothiazide
B. Lisinopril
C. Metoprolol
D. Spironolactone

Answer :

Final answer:

D. Spironolactone should be discontinued prior to screening for secondary causes of hypertension in the patient described to avoid interference with the evaluation process.

Explanation:

Hypertension, commonly known as high blood pressure, is a condition characterized by chronically elevated blood pressure, typically defined as consistent readings of 140/90 mm Hg or higher. For individuals with resistant hypertension, such as the 58-year-old man mentioned, screening for secondary causes is a critical step. Secondary hypertension can be caused by underlying conditions such as chronic kidney disease or endocrine disorders like Cushing's disease. When preparing for such screening, certain medications may mask or affect the underlying cause.

The medication Spironolactone, a potassium-sparing diuretic that is also an aldosterone antagonist, can potentially interfere with the evaluation for secondary causes of hypertension, such as primary aldosteronism, and therefore should be discontinued prior to screening. Unlike Spironolactone, Thiazide diuretics like Hydrochlorothiazide, ACE inhibitors like Lisinopril, and beta-blockers like Metoprolol do not typically need to be stopped prior to most screenings for secondary hypertension.

Considering this information, the correct answer to the question is D. Spironolactone, since discontinuing it would help provide a more accurate assessment for secondary causes of hypertension.

Learn more about Medication Discontinuation for Hypertension Screening here:

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