What should be the next step in management for a 62-year-old woman with recent onset hypertension despite three medications and a family history of heart disease?

In this scenario, listening closely to the abdomen for bruits is a sensible next step in management for several reasons. First, the patient is experiencing recent onset hypertension, which is notable given her age and the fact that she is already on multiple antihypertensive medications. This raises the possibility of secondary causes of hypertension, one of which could be renal artery stenosis.

Bruits in the abdomen, particularly over the renal arteries, may indicate turbulent blood flow associated with stenosis. Identifying a bruit would help in confirming or ruling out this potential cause of her hypertension. Detecting bruits is a non-invasive initial assessment that is valuable in understanding the underlying mechanisms of her elevated blood pressure.

The other options, while potentially relevant, may not address the immediate need to investigate the cause of her recent onset hypertension. Ordering a chest X-ray does not directly assess for renal artery involvement or investigate secondary hypertension causes, and increasing her antihypertensive medications without understanding the underlying issue could lead to unnecessary side effects or complications. A referral to a cardiologist may ultimately be warranted, but the first step should focus on diagnosis rather than management escalation at this stage.

Conducting an assessment for bruits provides a critical diagnostic approach to understanding the patient's condition effectively