Image of the Week: What is causing this patient’s resistant hypertension?

A 54-year-old man presents with fatigue, lethargy, and frequent headaches. He has a 1-year history of hypertension that has been resistant to treatment, and on examination his blood pressure is 145/82 mm Hg. Laboratory tests reveal a serum potassium level of 3.1 mmol/L. Subsequent examination demonstrates an increased ratio of plasma aldosterone concentration to plasma renin activity and the findings seen here on CT. Based on this patient’s most likely diagnosis, which of the following medications should be initiated? Learn more about this case, take the quiz, and join the conversation on Figure 1.

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