Appropriate Screening Test for This Patient
The most appropriate screening test is B - Fasting blood glucose. 1, 2
Rationale Based on Patient Risk Profile
This patient presents with multiple high-risk features that mandate diabetes screening:
Hypertension for 5 years - The USPSTF specifically recommends screening for type 2 diabetes in adults with hypertension (Grade B recommendation), as detecting diabetes in hypertensive patients substantially improves cardiovascular risk stratification and guides treatment decisions 1
BMI of 37 (Class II Obesity) - This creates a synergistic effect with hypertension that accelerates both cardiovascular disease and diabetes onset 2
Combined risk amplification - The combination of hypertension and obesity creates a particularly high-risk phenotype, with studies showing that obesity doubles the risk of developing diabetes in hypertensive patients 2
Why Fasting Blood Glucose is the Correct Choice
Fasting plasma glucose (FPG) is the recommended screening test because it is:
- Easier and faster to perform than alternatives 1
- More convenient and acceptable to patients 1
- Less expensive than other screening tests 1
- More reproducible than 2-hour plasma glucose testing with less intraindividual variation 1
- Has similar predictive value for development of microvascular complications 1
The diagnostic threshold is ≥126 mg/dL (≥6.99 mmol/L), with confirmation recommended on a separate day 1
Why Other Options Are Incorrect
A - Fecal occult blood testing: While colorectal cancer screening is important, the patient's age is not specified. This would typically begin at age 45-50 in average-risk individuals, but the immediate priority given the documented hypertension and severe obesity is metabolic screening 2
C - Pap smear: Gender is not specified in the question. If female, cervical cancer screening would be appropriate but is not the most urgent priority given the cardiovascular and metabolic risk profile 2
D - Lung cancer screening: Would only be indicated if the patient is aged 50-80 years with a 20 pack-year smoking history and currently smokes or quit within the past 15 years. No smoking history is mentioned.
Clinical Context and Urgency
The prevalence of undiagnosed diabetes in hypertensive patients ranges from 15-20%, making screening in this population particularly high-yield 2. The American Heart Association emphasizes that fasting blood glucose should be measured as part of basic laboratory investigations in all patients with hypertension 1, 2. Annual screening is warranted in high-risk patients with the combination of hypertension and obesity 2.
Additional Screening Considerations
While fasting blood glucose is the priority, this patient should also receive:
- Complete metabolic panel including lipid profile, serum creatinine with eGFR, and electrolytes 1, 2
- Urinalysis to detect proteinuria or kidney damage 1, 2
- ECG to assess for left ventricular hypertrophy 1, 2
- Thyroid-stimulating hormone 1, 2
The key clinical pitfall to avoid is delaying diabetes screening in hypertensive patients with obesity, as early detection allows for integrated cardiovascular risk reduction through blood pressure control, glycemic management, and lipid optimization 1, 2.