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8th February 2024
A 58-year-old gentleman is referred to the clinic for worsening hypertension despite treatment with amlodipine, ramipril and Bendroflumethiazide.
A 58-year-old gentleman is referred to the clinic for worsening hypertension despite treatment with amlodipine, ramipril and Bendroflumethiazide. On examination, his BP is 162/97, and a left carotid bruit is heard. Urinalysis is negative, and blood results are as follows:
| Investigation | Result | Normal value |
|---|---|---|
| Haemoglobin | 120 g/l | 135-175 g/l |
| White cell count | 6.0 x 10⁹/l | 4-11 x 10⁹/l |
| Platelets | 260 x 10⁹/l | 150-400 x 10⁹/l |
| Sodium | 140 mmol/l | 135-145 mmol/l |
| Potassium | 5.3 mmol/l | 3.5-5.0 mmol/l |
| Creatinine | 190 micromol/l | 50-120 micromol/l |
His previous creatinine six months prior was 144 micromol/l/
What is the most likely cause of the patient’s hypertension?
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