65-year-old man comes to the physician for follow-up on inadequately controlled hypertension

65-year-old man comes to the physician for follow-up on inadequately controlled hypertension. He has no complaints except

difficulty walking uphill or climbing stairs due to right thigh pain; he must stop and rest for the pain to go away. His other medical

problems include stable angina that required coronary angioplasty and stenting 2 years ago, hypercholesterolemia, a 20-year history

of hypertension, and a 10-year history of type 2 diabetes mellitus. His medications include aspirin, metoprolol, valsartan,

hydrochlorothiazide, amlodipine, pravastatin, metformin, and glyburide He smokes 1Ā½packs of cigarettes daily and does not

consume alcohol. His blood pressure is 176/100 mm Hg in the left arm and 180/100 mm Hg in the right Which of the fol1owing is the

most likely additional finding in this patient?

  • Q A Continuous bruit in the right periumbilical area
  • Q B. High aldosterone/renin ratio >201
  • Q C. Increased 24-hour urinary free cortisol excretion
  • Q D. Increased urinary excretion of vanillylmandelic acid
  • 0 E. Rib notching on chest x-ray

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