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An 80-year-old man has a past medical history of hypertension and migraine headaches. His BP today is 158/72 and 156/70 mm Hg; heart rate is 70 beats/min; serum creatinine is 1.6 mg/dL; and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70 in tall, smokes one pack of cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following is the most appropriate recommendation for his antihypertensive regimen? |
| | A) | Add propranolol and hydrochlorothiazide |
| | B) | Change lisinopril to a metoprolol and furosemide |
| | C) | Add hydrochlorothiazide |
| | D) | Add furosemide |
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2 | |
An 80-year-old man has a past medical history of hypertension and migraine headaches. His BP today is 158/72 and 156/70 mm Hg; heart rate is 70 beats/min; serum creatinine is 1.6 mg/dL; and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70 in tall, smokes one pack of cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following lifestyle modifications are most reasonable to recommend in this patient to lower his blood pressure? |
| | A) | Weight loss |
| | B) | Smoking cessation |
| | C) | Adopting a DASH eating plan |
| | D) | Decreasing ethanol consumption |
| | E) | All of the above |
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3 | |
A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by this physician her BP was 120/80 mm Hg. She is extensively interviewed and examined and has no signs of acute or chronic target organ damage. Her BP is measured again 20 minutes later by another person (her physician), and it is 140/88 and 140/90 mm Hg. Which of the following is the most accurate clinical assessment of her present situation? |
| | A) | Prehypertension |
| | B) | Elevated blood pressure |
| | C) | Stage 1 hypertension |
| | D) | White coat hypertension |
| | E) | Hypertensive urgency |
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4 | |
A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by this physician her BP was 120/80 mm Hg. She is extensively interviewed and examined and has no signs of acute or chronic target organ damage. Her BP is measured again 20 minutes later by another person (her physician), and it is 140/88 and 140/90 mm Hg. Which of the following is most appropriate BP goal in this patient? |
| | A) | <115/75 mm Hg |
| | B) | <120/80 mm Hg |
| | C) | <130/80 mm Hg |
| | D) | <140/90 mm Hg |
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5 | |
A 60-year-old woman with hypertension and left ventricular dysfunction (systolic heart failure) is seen 2 months after an acute myocardial infarction (MI). Her present BP is 130/84 and 132/82 mm Hg with a heart rate of 60 beats/min. Her serum creatinine is 1.1 mg/dL; serum potassium is 3.5 mEq/L; and spot urinalysis shows 40 mg albumin per gram of creatinine. She has no edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, and enalapril 20 mg twice daily. Which of the following conditions justifies the use of carvedilol in this patient? |
| | A) | Heart failure |
| | B) | Post-mi |
| | C) | Chronic kidney disease |
| | D) | A and B |
| | E) | A, B, and C |
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6 | |
A 60-year-old woman with hypertension and left ventricular dysfunction (systolic heart failure) is seen 2 months after an acute myocardial infarction (MI). Her present BP is 130/84 and 132/82 mm Hg with a heart rate of 60 beats/min. Her serum creatinine is 1.1 mg/dL; serum potassium is 3.5 mEq/L; and spot urinalysis shows 40 mg albumin per gram of creatinine. She has no edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, and enalapril 20 mg twice daily. Which of the following statements is most appropriate to include when counseling this patient regarding her antihypertensive therapy? |
| | A) | It will be possible to stop enalapril if your bp is at goal for 12 consecutive months |
| | B) | If you experience depression stop carvedilol and seek emergency care |
| | C) | Long-term benefits of these medications include a reduced risk of CV events |
| | D) | If you experience a dry cough stop lisinopril to avoid the development of angioedema |
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7 | |
Which of the following statements is (are) true regarding diuretics in the treatment of hypertension? |
| | A) | Thiazide-type diuretics are first-line agents because they lower BP and lower risk of CV events |
| | B) | The ALLHAT study showed that nonfatal MI and coronary heart disease are reduced more with chlorthalidone than with amlodipine or lisinopril |
| | C) | Loop diuretics are preferred over thiazide-type diuretics in patients with chronic kidney disease |
| | D) | A and B |
| | E) | A, B, and C |
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8 | |
Which of the following is true regarding prehypertension? |
| | A) | All patients with BP values that are >120/80 mm Hg have prehypertension |
| | B) | The JNC7 and AHA guidelines encourage, but do not recommend, aggressive lifestyle modifications in all patients with prehypertension |
| | C) | Most patients with prehypertension will not develop hypertension in their lifetime |
| | D) | Patients with prehypertension have higher CV risk than patients with normal BP values |
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9 | |
A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and amlodipine 5 mg daily for 6 years. She was on captopril and enalapril several years ago, but both were stopped because of a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 148/78 and 148/76 mm Hg with a heart rate of 100 beats/min. Her urinalysis shows microalbuminuria; serum creatinine is 1.5 mg/dL; potassium is 4.1 mEq/L; weight is 75 kg; and height is 66 in. Her only complaint is headache. Which of the following is (are) routine monitoring parameters for her antihypertensive drug therapy? |
| | A) | Heart rate |
| | B) | Serum potassium, sodium, and magnesium |
| | C) | Serum creatinine and BUN |
| | D) | All of the above |
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10 | |
A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and amlodipine 5 mg daily for 6 years. She was on captopril and enalapril several years ago, but both were stopped because of a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 148/78 and 148/76 mm Hg with a heart rate of 100 beats/min. Her urinalysis shows microalbuminuria; serum creatinine is 1.5 mg/dL; potassium is 4.1 mEq/L; weight is 75 kg; and height is 66 in. Her only complaint is headache. Losartan 50 mg daily is added to her regimen. Four weeks later, her BP is 132/82 and 134/80 mm Hg; serum creatinine is 1.9 mg/dL; and potassium has increased to 4.4 mEq/L. Which of the following is the most appropriate option to treat this patient’s hypertension? |
| | A) | Stop losartan and start ramipril |
| | B) | Increase losartan to 100 mg daily |
| | C) | Increase hydrochlorothiazide to 50 mg daily |
| | D) | Add eplerenone 25 mg daily |
| | E) | Decrease losartan to 25 mg daily |
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11 | |
Which of the following is true regarding the use of alternative agents in the treatment of hypertension? |
| | A) | Severe bradycardia occurs when direct vasodilators are used with a ß-blocker |
| | B) | They all cause severe rebound hypertension when stopped abruptly |
| | C) | Reserpine is poorly tolerated and causes anticholinergic side effects |
| | D) | Most agents should given in combination with at least a thiazide-type diuretic |
| | E) | All of the above |
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12 | |
A 65-year-old woman with type 2 diabetes, hypertension, osteoporosis, and atrial fibrillation has a BP of 150/96 and 150/90 mm Hg, heart rate of 68 beats/min, potassium of 3.2 mEq/L, and a serum creatinine of 2.3 mg/dL. She reports an allergy to chlorthalidone (severe gout). Presently, she is on diltiazem CD 360 mg daily and furosemide 40 mg twice daily. At this point in her care, which of the following agents would be the most rational addition to her regimen? |
| | A) | Hydrochlorothiazide 12.5 mg daily |
| | B) | Amlodipine 5 mg daily |
| | C) | Doxazosin 1 mg daily |
| | D) | Atenolol 25 mg daily |
| | E) | Olmesartan 20 mg daily |
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13 | |
Which of the following is preferred as add-on therapy for a patient who is status post-MI (1 month ago) with a BP of 146/88 and 144/86 mm Hg while treated with metoprolol XL 200 mg daily? |
| | A) | Chlorthalidone |
| | B) | Valsartan |
| | C) | Eplerenone |
| | D) | Amlodipine |
| | E) | Lisinopril |
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14 | |
Which of the following is preferred as initial antihypertensive therapy for a 63-year-old woman who is diagnosed with hypertension and has a history of ischemic stroke (6 months ago), with a BP of 166/108 and 164/106 mm Hg? |
| | A) | A thiazide-type diuretic with an ACE inhibitor |
| | B) | A thiazide-type diuretic with a nonselective ß-blocker |
| | C) | An ARB alone |
| | D) | A thiazide-type diuretic alone |
| | E) | An ACE inhibitor alone |
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15 | |
Which of the following is preferred as initial antihypertensive therapy for a 52-year-old patient with chronic stable angina and hypertension, who is experiencing chest pain twice weekly while on atenolol 100 mg daily with a BP of 146/90 and 144/92 mm Hg and heart rate of 58 beats/min? |
| | A) | Hydrochlorothiazide 12.5 mg daily |
| | B) | Quinapril 20 mg daily |
| | C) | Diltiazem SR 180 mg daily |
| | D) | Nifedipine SR 30 mg daily |
| | E) | Valsartan 160 mg daily |
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