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September 24, 1997

A 42-Year-Old Man With Hypertension

Author Affiliations

Dr Oparil is Director of the Vascular Biology and Hypertension Program, Professor of Medicine, and Professor of Physiology and Biophysics, University of Alabama School of Medicine, Birmingham.

JAMA. 1997;278(12):1015-1021. doi:10.1001/jama.1997.03550120075037

Dr Delbanco:  Mr J is a 42-year-old African-American man first diagnosed with hypertension when he was 28 years old. He is married, lives in an apartment in the inner city of Boston with his wife and child, and works in an accounting department. He has health insurance through a managed care plan.His family history for hypertension is striking. His father died at the age of 69 years of complications of hypertension, with multiple strokes and congestive heart failure. His mother died at age 55 years of complications of hypertension and congestive heart failure. His 6 siblings do not have hypertension, but 3 have asthma.After being found hypertensive, Mr J underwent an evaluation for secondary causes, including physical examination, urinalysis, electrolytes, serum urea nitrogen, creatinine, serum creatinine, and thyroid function tests; all findings were normal. He stopped smoking in 1991 after a 12 pack-year history and has not smoked