A 42-year-old woman comes to the physician because of frequent episodes of headaches over the past 3 months. One week ago, she had a brief episode of right arm weakness and numbness that lasted for 3 minutes before spontaneously resolving. She is otherwise healthy and takes no medications. She has smoked one-half pack of cigarettes daily for 22 years. Her pulse is 82/min and blood pressure is 156/104 mm Hg. Neurologic examination shows no focal lesions. Abdominal examination shows no masses or tenderness. A bruit is heard on auscultation of the abdomen. Blood testing in this patient would most likely show which of the following?

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Eductional Objective: Renal artery stenosis (eg, severe hypertension, abdominal bruits) causes decreased renal artery perfusion, which activates the renin-angiotensin-aldosterone system. Increased secretion of renin leads to increased production of angiotensin I and angiotensin II, which causes increased peripheral resistance and elevated systemic blood pressure. Increased aldosterone secretion causes increased renal Na⁺ reabsorption and K⁺ and H⁺ excretion, resulting in relative hypokalemia and metabolic alkalosis.

A 42-Year-Old Woman Comes to the Physician Because of Frequent