History and Physical Exam

History

A 35-year-old man presented with with elevated blood pressure (188/112, seated) at a yearly physical exam. Previous exams noted blood pressures of 160/94 and 158/92. On questioning, he admitted episodes about twice a month of apprehension, severe headache, perspiration, rapid heartbeat, and facial pallor. These episodes had an abrupt onset and lasted 10-15 minutes.

Physical Exam

30 min after the initial blood pressure measurement, the seated blood pressure was 178/110 with a heart rate of 90. The blood pressure after 3 min of standing was 152/94 with a heart rate of 112. The optic fundi showed moderately narrowed arterioles with no hemorrhages or exudates.

Initial lab studies

Routine hematology and chemistry studies were within the reference ranges and a chest film and EKG were essentially normal.

Questions

  1. How would you assess this patient's presentation?
  2. What laboratory tests would you order to evaluate this patient?