This patient is abnormally young to have essential hypertension, and the renal bruit is highly suggestive of a secondary cause of the condition: renal artery stenosis caused by fibromuscular dysplasia (FMD). FMD is more common in young females (85%-90% of patients are women). The exact etiology of the condition is unknown, but renal artery stenosis causing hypertension is a common presentation. Renal angiography is the diagnostic modality of choice, although duplex ultrasonography, CT angiography, and MR angiography can also be utilized. Etiologies that can mimic fibromuscular dysplasia include atherosclerosis and vasculitis. The patient has no physical findings to make one suspect Cushing syndrome (abnormal fat distribution, ecchymoses, hirsutism, etc.), congenital adrenal hyperplasia (virilization), or coarctation of the aorta (BP lower in legs than in arm). She does not have the metabolic alkalosis and hypokalemia of primary hyperaldosteronism