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Dietary management of hyperinsulinemia-driven hypertension
Learning Objectives
Eleanor B., 61F, presents with 'resistant hypertension': BP 152/94 on three antihypertensives (lisinopril 20mg, amlodipine 10mg, hydrochlorothiazide 25mg). Her cardiologist has recommended adding a fourth agent. Metabolic labs: fasting glucose 104 mg/dL, HbA1c 5.7%, fasting insulin 19.8 μIU/mL, HOMA-IR 5.1, TG 188, HDL 36, Na 142, K 3.4 mEq/L. She is on a 'heart-healthy' low-fat diet.
Eleanor's hypertension is most likely driven by: