A 70-year-old woman comes to the physician for a routine health maintenance examination. She has a 20-year history of hypertension managed with hydrochlorothiazide. Two months ago, her blood pressure was 145/80. Today, her blood pressure is 190/100. Fundoscopic examination shows AV nicking. A left carotid bruit is heard. Which of the following is the most likely explanation for this patient’s findings?
Conn syndrome
Cushing syndrome
Essential hypertension
Pheochromocytoma
Renal artery stenosis