Appropriate Screening Test for This Patient
For this patient with hypertension and BMI 37 (obesity), the most appropriate screening test is B - Fasting blood glucose. 1, 2
Rationale
This patient has two major risk factors that mandate diabetes screening:
- Hypertension for 5 years - a well-established cardiovascular risk factor that increases diabetes risk 3
- BMI 37 (Class II obesity) - obesity is strongly associated with diabetes and accelerates hypertension-related complications 4
Fasting blood glucose is specifically recommended as a core laboratory test for all patients with elevated blood pressure or confirmed hypertension. 1, 2 The combination of hypertension and obesity creates a particularly high-risk phenotype for diabetes, with studies showing that obesity doubles the risk of developing diabetes in hypertensive patients. 4
Why the Other Options Are Less Appropriate
Fecal Occult Blood (Option A)
- Colorectal cancer screening is important but not the priority in this preventive visit
- No age provided, but screening typically begins at age 45-50 for average-risk individuals
- The immediate metabolic risk from undiagnosed diabetes in this patient takes precedence
Pap Smear (Option C)
- Gender not specified in the question
- If female, cervical cancer screening is important but secondary to metabolic screening in a patient with hypertension and obesity
- Diabetes screening addresses immediate cardiovascular mortality risk 3
Lung Cancer Screening (Option D)
- Requires specific criteria: age 50-80 years, 20+ pack-year smoking history, current smoker or quit within 15 years
- No smoking history mentioned
- Not indicated without meeting these criteria
Clinical Context
The prevalence of undiagnosed diabetes in hypertensive patients is substantial, ranging from 15-20%. 3 More critically, obesity combined with hypertension creates a synergistic effect that accelerates both cardiovascular disease and diabetes onset. 4 Studies demonstrate that age at onset of hypertension is inversely related to BMI, and this relationship is even stronger when diabetes develops. 4
Screening for diabetes in hypertensive patients is cost-effective and prevents cardiovascular complications. 5, 6 Nearly one-third of adults with hypertension remain unscreened for diabetes, representing missed opportunities for early intervention. 6
Recommended Screening Approach
Initial screening should include: 1, 2
- Fasting blood glucose (primary screening test)
- Complete metabolic panel with serum creatinine and eGFR 1, 2
- Lipid profile 1, 2
- Urinalysis with consideration for urine albumin-to-creatinine ratio 1, 2
- 12-lead ECG 1, 2
If fasting glucose is 100-125 mg/dL (prediabetes range), consider adding HbA1c for confirmation. 5, 7 The combination of fasting glucose and HbA1c has 100% sensitivity for detecting diabetes in hypertensive patients. 5
Common Pitfalls to Avoid
- Do not delay diabetes screening in obese hypertensive patients - this population has the highest risk 4, 6
- Do not rely on symptoms alone - many patients with diabetes and prediabetes are asymptomatic 6
- Do not assume previous screening is adequate - annual screening is warranted in high-risk patients like this one 3
This patient's combination of 5-year hypertension history and BMI 37 places them at very high risk for diabetes, making fasting blood glucose the single most important screening test to perform at this preventive visit. 1, 2, 4