RN Nursing · Hypertension · Practice question
Which finding most strongly suggests secondary hypertension?
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Family history with onset at age 45
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Blood pressure controlled on two agents
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✓
Persistent elevation despite three agents, including a diuretic
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Obesity and sedentary lifestyle
Answer & explanation
Correct: Persistent elevation despite three agents, including a diuretic
Resistant hypertension — defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which is a diuretic, at optimal doses — is the hallmark clinical indicator of secondary hypertension. Secondary hypertension has an identifiable underlying cause such as primary aldosteronism, renal artery stenosis, pheochromocytoma, or obstructive sleep apnea. When three appropriately selected agents fail to achieve blood pressure control, a secondary etiology must be actively investigated. A family history with onset at age 45 (option A) is more consistent with essential (primary) hypertension, which has a strong genetic component and typically manifests in middle age. Blood pressure controlled on two agents (option B) indicates responsive, not resistant, hypertension and does not raise concern for a secondary cause. Obesity and a sedentary lifestyle (option D) are major modifiable risk factors for primary hypertension and do not themselves suggest a secondary etiology. The pattern of treatment-resistant hypertension triggers a systematic workup including plasma aldosterone-to-renin ratio, renal imaging, 24-hour urine catecholamines, and polysomnography, depending on clinical suspicion, to identify and treat the root cause.
Study note
Hypertension: NCLEX Study Guide
A structured nursing review of hypertension covering ACC/AHA classification, primary vs secondary causes, diagnostic workup, stepwise management, hypertensive crisis, and target organ damage.
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