Question

a 55 - year - old patient has a blood pressure of 138/85 on three occasions. the patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. what will the provider do next to evaluate this patient?
assess serum cortisol levels
continue to monitor blood pressure at each health maintenance visit
order urinalysis, cbc, bun, and creatinine
refer to a specialist for a sleep study

Explanation:

The patient has a blood pressure of 138/85 (elevated blood pressure). The next step in evaluation for elevated blood pressure (before considering secondary causes like Cushing's - which would involve assessing serum cortisol levels, or sleep apnea - which would involve a sleep study) is to do basic laboratory tests like urinalysis (to check for kidney - related issues), CBC (to check for anemia or polycythemia which can affect blood pressure), BUN (blood urea nitrogen) and creatinine (to assess kidney function). Monitoring at each health - maintenance visit is for pre - hypertension (systolic 120 - 129 and diastolic <80) and this patient has elevated blood pressure (systolic 130 - 139 or diastolic 80 - 89).

Answer:

Order urinalysis, CBC, BUN, and creatinine.