9th May 2025

A 28-year-old male presents to the general medicine clinic due to ongoing difficulty treating his hypertension.

A 28-year-old male presents to the general medicine clinic due to ongoing difficulty treating his hypertension. He initially presented to the GP with altered vision and headaches and was found to be hypertensive at 180/90 mmHg on ambulatory blood pressure monitoring. His past medical history includes asthma and anxiety. 

His current medication is Ramipril 10mg OM, fluoxetine 60mg OD, and salbutamol inhaler PRN.

His diligent GP has enclosed the following investigation results with the referral letter.

On examination, he appears comfortable at rest. His BP on his left upper limb is 180/80 mmHg, HR 84 bpm and regular. The radial pulse is strongly palpable. His lung bases are clear, with no additional sounds. An audible ejection systolic murmur is noted in the left upper sternal border. BMI is 28, and he currently uses an electronic cigarette. ETOH use is minimal.

There is no family history of hypertension or of early onset stroke. He states he is compliant with his medications. He works as an intensive care nurse within a local NHS trust.

Given the above clinical picture, which is the most likely clinical diagnosis attributed to his hypertension?

Select the SINGLE most appropriate option from the list below. Select ONE option only.