CASE PRESENTATION

• The patient, a 34-year-old man visited the clinic with complaints of frequent headaches, palpitations, and discomfort.
  His office blood pressure measurement was 136/86 mm Hg.
  ECG: Sinus Rhythm, Heart Rate 92 bpm.
  Other than being overweight (106 kg; BMI=28.2 kg/m2), his examination was unremarkable.
  A renal ultrasound showed normal-sized kidneys.
  Doppler examination did not show renal artery stenosis.
  His physician reassured him about the laboratory results and advised him to exercise.

MEDICAL HISTORY

• The patient was diagnosed with HTN when he was 22 years old, while in university.
  He was then told that the elevated blood pressure was related to academic stress.
  In the past, his BP levels were in range of 140-150 / 91-100-mm Hg and he weighed approximately 86 kg (body mass index [BMI] approximately 26.1 kg/m²).
  He was not treated when he was diagnosed and was advised to change his lifestyle (i.e weight loss, exercice, low salt ..).
  When he was 27 years old, he started working for a software start up.
  He informed his physician that his mother and brother were known cases of HTN.
  He was not aware of any history of strokes, kidney disease, endocrine tumors, or hypokalemia.

QUESTIONS