From the Guidelines
The most appropriate screening test to recommend for this 34-year-old woman with elevated blood pressure is a fasting blood glucose level (option B). This patient has consistently elevated blood pressure readings, including the current office reading of 154/92 mmHg, which confirms hypertension 1. When evaluating a patient with newly diagnosed hypertension, it's essential to screen for other cardiovascular risk factors and metabolic conditions that often coexist with hypertension. Diabetes is a common comorbidity with hypertension and significantly increases cardiovascular risk when present 1. A fasting blood glucose test is part of the standard initial workup for patients with hypertension to identify potential diabetes or prediabetes, which would influence management decisions.
Some key points to consider in this patient's evaluation include:
- The importance of confirming hypertension with accurate blood pressure measurements, as outlined in the USPSTF recommendation statement 1
- The need to assess for other cardiovascular risk factors, such as diabetes, in patients with newly diagnosed hypertension 1
- The role of family history in assessing cardiovascular risk, although in this case, the family history of breast cancer and myocardial infarction at older ages does not directly influence the choice of screening test 1
The other options are less appropriate in this clinical context:
- BRCA testing is not indicated based on her family history (only one relative with breast cancer diagnosed after age 60)
- A Pap smear is not urgently needed as her last one was only 2 years ago and previous results were normal
- Renal ultrasonography is not routinely indicated for initial hypertension evaluation without signs of renal disease
- A stress test would only be warranted if there were symptoms or high risk factors suggesting coronary artery disease, which are not present here 1
From the Research
Patient Evaluation
The patient is a 34-year-old woman with a family history of hypertension and a recent blood pressure reading of 154/92 mmHg. She has been monitoring her blood pressure at home, with readings ranging from 135/86 mmHg to 140/90 mmHg.
Screening Test Recommendations
Based on the patient's age, family history, and blood pressure readings, the following screening tests are considered:
- A. BRCA1 and BRCA2 screening: not recommended at this time, as the patient's family history of breast cancer is not sufficient to warrant genetic screening 2.
- B. fasting blood glucose level: recommended, as the patient's age and family history of hypertension put her at risk for developing type 2 diabetes 2, 3, 4, 5.
- C. Pap smear: not recommended at this time, as the patient's most recent Pap smear was 2 years ago and her results have always been normal.
- D. renal ultrasonography: not recommended at this time, as there is no evidence of kidney disease or other indications for renal imaging.
- E. stress test: not recommended at this time, as the patient has no symptoms of coronary artery disease and her blood pressure readings do not warrant further evaluation.
Rationale for Recommendations
The patient's family history of hypertension and her own elevated blood pressure readings put her at risk for developing cardiovascular disease. Screening for type 2 diabetes is recommended, as it can help identify individuals at risk for developing cardiovascular disease and allow for early intervention 2, 3, 4, 5. The other screening tests are not recommended at this time, as there is no evidence to suggest that they are necessary.
Key Findings
- The patient's blood pressure readings are elevated, with a recent reading of 154/92 mmHg.
- The patient's family history of hypertension and breast cancer puts her at risk for developing cardiovascular disease.
- Screening for type 2 diabetes is recommended, as it can help identify individuals at risk for developing cardiovascular disease and allow for early intervention 2, 3, 4, 5.