Fasting Blood Glucose is the Most Appropriate Screening Test
For this patient with 5 years of hypertension and BMI 37, fasting blood glucose screening for type 2 diabetes is the priority and should be performed immediately. 1, 2
Why Diabetes Screening Takes Priority
The combination of hypertension and Class II obesity (BMI 37) creates a particularly high-risk phenotype for undiagnosed diabetes that demands immediate screening:
The USPSTF provides a Grade B recommendation specifically for screening adults with hypertension for type 2 diabetes, with moderate certainty that this leads to substantial benefit in preventing cardiovascular events and death 1, 3
Hypertension combined with obesity creates compounded cardiovascular risk, and undiagnosed diabetes in hypertensive patients substantially elevates cardiovascular morbidity and mortality well before clinical diagnosis 2, 3
The prevalence of undiagnosed diabetes in hypertensive patients ranges from 15-20%, making this a high-yield screening intervention 2
Intensive blood pressure treatment in adults with both hypertension and diabetes leads to approximately 50% reduction in cardiovascular events over 5 years, but this benefit requires knowing the diabetes diagnosis 1
Screening Implementation
Fasting plasma glucose is the preferred screening test because of ease of administration, convenience, acceptability to patients, and lower cost compared to oral glucose tolerance testing 1
The European Society of Cardiology explicitly recommends fasting plasma glucose as part of routine laboratory investigations for all hypertensive patients 1
Multiple guidelines recommend screening beginning at age 45 years, and patients with BMI ≥25 kg/m² should be screened regardless of age 1, 3
Given the controlled hypertension and severe obesity, annual screening is warranted rather than the standard 3-year interval recommended for lower-risk populations 3
Why Other Options Are Not Priority
Fecal occult blood testing would be appropriate for colorectal cancer screening, but typically begins at age 45-50 years in average-risk individuals and is not the immediate priority in this clinical scenario [@general medical knowledge@]
Pap smear timing depends on the patient's sex, age, and screening history, but diabetes screening takes precedence given the immediate cardiovascular risk [@general medical knowledge@]
Lung cancer screening requires specific criteria including age 50-80 years and 20 pack-year smoking history, which are not mentioned in this case [@general medical knowledge@]
Clinical Pitfalls to Avoid
Do not delay diabetes screening in hypertensive patients even when blood pressure is "controlled", as metabolic abnormalities often precede overt diabetes diagnosis by years, and cardiovascular risk is substantially elevated during this pre-diagnostic period 3
Do not assume normal glucose metabolism based on absence of symptoms, as type 2 diabetes may remain undiagnosed for several years because hyperglycemia develops gradually 1
If fasting glucose is borderline (100-125 mg/dL indicating impaired fasting glucose), consider HbA1c measurement or oral glucose tolerance test for definitive diagnosis, as the combination improves detection sensitivity 1, 4, 5