A 36-year-old woman in the 34th week of gestation complains of increasing leg edema. On examination, blood pressure is 165/100 mm Hg and there is moderate pretibial edema. Laboratory studies indicate normal creatinine, uric acid, platelet count, and liver enzymes, and 24-hour urine protein excretion is 200 mg. She is otherwise without symptoms and fetal test- ing is normal. What are the most likely diagnosis and the most appropriate treatment approach? 

A 46-year-old man comes for confirmation of elevated blood pressure measured at a community screening. On subsequent visits over the next 2 months, stage 1 hypertension is confirmed. He does not use alcohol but is sedentary and eats a high-salt diet. Physical examination is normal except for blood pressure of 144/96 mm Hg, body mass index of 29 kg/m2, and waist circumference of 44 inches. Abnormal laboratory study results are total cholesterol 220 mg/dL, low-density lipoprotein cho- lesterol 124 mg/dL, high-density lipoprotein cholesterol 30 mg/dL, triglycerides 180 mg/dL, and fasting glucose 110 mg/dL. What is the most appropriate approach for this patient? 

A 32-year-old woman has a blood pressure of 140/100 mm Hg on repeated office measurements. There is a family history of hypertension. Her body mass index is normal. She exercises regularly. She always adds salt to her food. Her only medica- tion is an oral contraceptive that she has taken for 15 years. Except for elevated blood pressure, the examination findings are normal. What is the most appropriate recommendation for this patient? 

A 36-year-old man complains of headaches for the past 6 months. Headaches are abrupt in onset, bitemporal in loca- tion, and described as pounding in nature. They are frequently associated with palpitations and diaphoresis. Symptoms often suddenly abate after 30 to 45 minutes. Blood pressure mea- surements during the headaches are elevated and have been as high as 220/140 mm Hg. There is no family history of hyper- tension. The patient uses no medications other than an over- the-counter decongestant, which he takes daily for treatment of vasomotor rhinitis. Examination findings are normal except for a blood pressure of 140/100 mm Hg. Results of routine laboratory studies are normal. What is the most appropriate next step in the evaluation of this patient? 

A 65-year-old man with a 20-year history of hypertension pre- sents to the emergency department complaining of the sudden onset of a sharp, “tearing,” periscapular pain. Chest radiogra- phy suggests a widening of the mediastinum, and a subsequent CT angiogram demonstrates a distal (descending) aortic dissection. Blood pressure is 180/120 mm Hg and pulse is 94 beats per minute. What is the most appropriate approach to lower the blood pressure in this situation?