A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l }
\text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \
\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \
\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \
\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \
\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \
\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \
\text { Urinalysis: } & 3 + \text { proteinuria }
\end{array}$$
-An angiotensin-converting enzyme inhibitor is administered to a 65-year-old man with a 20-year history of hypertension. The drug lowered arterial pressure and increased plasma levels of renin and bradykinin. An increase in which of the following would best explain the decline in blood pressure?

Question

A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l } 
\text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \
\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \
\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \
\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \
\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \
\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \
\text { Urinalysis: } & 3 + \text { proteinuria }
\end{array}$$
-An angiotensin-converting enzyme inhibitor is administered to a 65-year-old man with a 20-year history of hypertension. The drug lowered arterial pressure and increased plasma levels of renin and bradykinin. An increase in which of the following would best explain the decline in blood pressure?

Quizplus · Accepted Answer

The Answer is E

A 40-Year-Old Woman with a 16-Year History of Diabetes Mellitus