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VOLUME 1 ISSUE 3 CASE SW	SW is a 49-year-old man who presents for an employment physical. He has not seen a physician in the last 10 years, but considers himself healthy. He has had no hospitalizations as an adult.
PHYSICAL EXAM »  Height: 5 ft. 8 in. »  Weight: 200 lbs. »  Body mass index (BMI): 30 »  Waist circumference: 42 in. »  Pulse: 84 »  Blood pressure: 150/95 mm Hg »  Diminished pedal pulses »  Absent Achilles reflexes »  Remainder of examination is normal LABORATORY VALUES »  Fasting blood glucose: 118 mg/dL »  Uric acid: 9 mg/100 mL »  Remainder of chemistry panel is normal »  Lipid profile   --  Total cholesterol: 190 mg/dL   --  Triglycerides; 190 mg/dL   --  HDL: 19 mg/dL   --  Calculated LDL cholesterol: 133 mg/dL   --  hs CRP: 2.0 mg/dL (normal, <0.8)   --  Microalbumin/creatinine ratio: 40 µg/mg creatinine (normal, <30) NAVIGATION »  Q1: What findings are of concern to you at this visit? »  Q2: What other findings are suggestive of the Insulin Resistance Syndrome? »  Q3: How would you categorize SW’s blood pressure? »  Q4: What are the benefits of treating hypertension? »  Q5: What is the recommended initial therapy for patients with hypertension? »  Q6: What other management strategies would you institute at this time? »  Q7: How do you explain SW’s worsening lipid profile and fasting glucose levels? »  Q8: What is your diagnosis now? »  Q9: What are your treatment goals for SW? »  Q10: How should you modify SW’s antihypertensive regimen at this time?	Q: What findings are of concern to you at this visit? A: Although his elevated blood pressure may initially cause your greatest concern, SW displays essentially all of the features of the Insulin Resistance Syndrome (Table 1).1 Approximately 50% of patients with hypertension have insulin resistance and/or hyperinsulinemia, so you should have a high degree of suspicion for this syndrome if other positive indicators are present in a patient with hypertension.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.edu/jeffcme
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