Screening Test Recommendation for Hypertensive Female Patient
This patient should undergo random blood glucose screening (Option C) as the priority screening test. 1, 2
Rationale for Diabetes Screening
The combination of hypertension and elevated BMI creates a particularly high-risk phenotype for undiagnosed diabetes, with prevalence rates of 15-20% in this population. 2 The American Diabetes Association explicitly recommends screening adults with BMI ≥25 kg/m², and the USPSTF provides a Grade B recommendation for screening adults with hypertension for type 2 diabetes, with moderate certainty that this leads to substantial benefit in preventing cardiovascular events and death. 2, 3, 4
Key Supporting Evidence
Cardiovascular risk stratification: The European Society of Cardiology recommends fasting plasma glucose as part of routine laboratory investigations for all hypertensive patients during initial assessment. 1, 2
Mortality and morbidity impact: Undiagnosed diabetes in hypertensive patients substantially elevates cardiovascular morbidity and mortality well before clinical diagnosis, and intensive blood pressure treatment in adults with both conditions leads to approximately 50% reduction in cardiovascular events over 5 years—but this benefit requires knowing the diabetes diagnosis. 2
Screening frequency: Given controlled hypertension and elevated BMI, annual screening is warranted rather than the standard 3-year interval recommended for lower-risk populations. 3
Why Not the Other Options
Fecal Occult Blood Testing (Option A)
While colorectal cancer screening is important for age-appropriate patients, the question specifically addresses a preventive clinic visit for a hypertensive patient with elevated BMI. The immediate cardiovascular risk from undiagnosed diabetes takes priority in this clinical context. 1
Pap Smear (Option B)
Cervical cancer screening follows age-based and risk-based guidelines independent of hypertension status. Without knowing the patient's age or cervical cancer screening history, this cannot be prioritized over metabolic screening in a hypertensive patient with elevated BMI. 1
Clinical Implementation
Use fasting plasma glucose as the initial screening test, as this is explicitly recommended by the European Society of Cardiology for all hypertensive patients. 2 If fasting glucose is borderline (indicating impaired fasting glucose), consider HbA1c measurement or oral glucose tolerance test for definitive diagnosis, as the combination improves detection sensitivity. 3
Critical Pitfall 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 The prevalence of undiagnosed diabetes in hypertensive patients ranges from 15-20%, making this a high-yield screening intervention. 2