Family Medicine Hypertension Questions and Answers
2024
Which of the following requires monitoring in a patient on HCTZ? Select all that apply.
A
Renal function
B
Hepatic function
C
Electrolytes
D
Uric acid
E
Blood glucose - Answers a, c, d, and e are correct. These are all effects of HCTZ and should be
monitored or followed.
Answer b is incorrect. HCTZ is not associated with liver effects and therefore hepatic function does
not need to be monitored.
DL is a 35-year-old man recently diagnosed with type 2 diabetes, hypertension, hyperlipidemia, and
sexual dysfunction induced by diabetic neuropathy. Which of the following two-drug regimens is
most appropriate to initiate in DL for antihypertensive therapy?
A
Amlodipine + lisinopril
B
Short-acting nifedipine + trandolapril
,C
Doxazosin + HCTZ
D
Pindolol + losartan
E
HCTZ + lisinopril - Answer a is correct. A RAAS agent, such as an ACEI or an ARB, is indicated for
renal protection in the diabetes population. Therefore, lisinopril is an appropriate first-line option for
the treatment of hypertension in this patient. A CCB such as amlodipine is appropriate, given that
calcium channel blockers have equal antihypertensive efficacy (compared to an ACEI or a diuretic)
and have neutral effects on glucose homeostasis and on the lipid profile. This regimen is also least
likely to worsen sexual function.
Answer b is incorrect. Although an ACEI (trandolapril) is a good choice, short-acting CCBs should be
avoided because of an increase in side effects from the immediate release formulations (flushing,
headache).
Answer c is incorrect. The alpha-1 blocker doxazosin would be a viable option in patients with
concomitant BPH; however, it is less effective in lowering blood pressure and not a first-line agent.
HCTZ, normally the agent of choice, would not be appropriate in this patient since diuretics have
negative effects on the lipid and glucose profile. In addition, other agents are available (CCBs).
Diabetes and hyperlipidemia are not absolute contraindications for diuretics but if they can be avoided
they should be.
Answer d is incorrect.Losartan is a viable option since patients with diabetes should be on an ACEI or
an ARB. However, pindolol is not the best option since BBs are not first-line and they often cause
sexual dysfunction. BBs with ISA, such as pindolol, have neutral effects on the lipid profile but can
still worsen glucose homeostasis. In addition, BBs can mask signs and symptoms of hypoglycemia
(except for sweating).
Answer e is incorrect. This would be a good first-line regimen, except HCTZ can worsen glucose
intolerance and the lipid profile, whereas CCBs have neutral effects. Since a CCB like
Place the lifestyle modifications of weight reduction, moderation of alcohol consumption, and
physical activity in order of the decrease in expected/approximate systolic blood pressure reduction.
Start with the lowest expected decrease in SBP.
A
, Moderation of alcohol consumption, physical activity, weight reduction
B
Weight reduction, physical activity, moderation of alcohol consumption
C
Physical activity, moderation of alcohol consumption, weight reduction - Answer a is correct.
Moderation of alcohol consumption has an approximate range of a 2 to 4 mm Hg decrease in SBP.
Physical activity has an approximate range of 4 to 9 mm Hg decrease in SBP. Weight reduction has an
approximate range of 5 to 20 mm Hg per 10 kg decrease in SBP.
Answers b and c are incorrect. Those answers are not the correct ordered response of blood pressure
reduction starting with the lowest expected decrease in SBP.
According to the 2017 guidelines for hypertension, what is the BP goal for a 58-year-old African
American male with diabetes and chronic kidney disease?
A
<130/80 mm Hg
B
<140/90 mm Hg
C
<150/90 mm Hg
D
<160/100 mm Hg - Answer a is correct. All patients with hypertension and cardiovascular disease or
other comorbid conditions such as CKD and diabetes should have a goal blood pressure of <130/80
mm Hg.
Answers b, c, d are incorrect. For adults with confirmed hypertension and known stable CVD or
≥10% 10-year ASCVD risk, a BP target of <130/80 mm Hg is recommended. BP should be
categorized as normal, elevated, or stages 1 or 2 hypertension to prevent and treat high BP. Normal
BP is defined as <120/<80 mm Hg; elevated BP 120-129/<80 mm Hg; hypertension stage 1 is 130-
139 or 80-89 mm Hg, and hypertension stage 2 is ≥140 or ≥90 mm Hg. Prior to labeling a person with
2024
Which of the following requires monitoring in a patient on HCTZ? Select all that apply.
A
Renal function
B
Hepatic function
C
Electrolytes
D
Uric acid
E
Blood glucose - Answers a, c, d, and e are correct. These are all effects of HCTZ and should be
monitored or followed.
Answer b is incorrect. HCTZ is not associated with liver effects and therefore hepatic function does
not need to be monitored.
DL is a 35-year-old man recently diagnosed with type 2 diabetes, hypertension, hyperlipidemia, and
sexual dysfunction induced by diabetic neuropathy. Which of the following two-drug regimens is
most appropriate to initiate in DL for antihypertensive therapy?
A
Amlodipine + lisinopril
B
Short-acting nifedipine + trandolapril
,C
Doxazosin + HCTZ
D
Pindolol + losartan
E
HCTZ + lisinopril - Answer a is correct. A RAAS agent, such as an ACEI or an ARB, is indicated for
renal protection in the diabetes population. Therefore, lisinopril is an appropriate first-line option for
the treatment of hypertension in this patient. A CCB such as amlodipine is appropriate, given that
calcium channel blockers have equal antihypertensive efficacy (compared to an ACEI or a diuretic)
and have neutral effects on glucose homeostasis and on the lipid profile. This regimen is also least
likely to worsen sexual function.
Answer b is incorrect. Although an ACEI (trandolapril) is a good choice, short-acting CCBs should be
avoided because of an increase in side effects from the immediate release formulations (flushing,
headache).
Answer c is incorrect. The alpha-1 blocker doxazosin would be a viable option in patients with
concomitant BPH; however, it is less effective in lowering blood pressure and not a first-line agent.
HCTZ, normally the agent of choice, would not be appropriate in this patient since diuretics have
negative effects on the lipid and glucose profile. In addition, other agents are available (CCBs).
Diabetes and hyperlipidemia are not absolute contraindications for diuretics but if they can be avoided
they should be.
Answer d is incorrect.Losartan is a viable option since patients with diabetes should be on an ACEI or
an ARB. However, pindolol is not the best option since BBs are not first-line and they often cause
sexual dysfunction. BBs with ISA, such as pindolol, have neutral effects on the lipid profile but can
still worsen glucose homeostasis. In addition, BBs can mask signs and symptoms of hypoglycemia
(except for sweating).
Answer e is incorrect. This would be a good first-line regimen, except HCTZ can worsen glucose
intolerance and the lipid profile, whereas CCBs have neutral effects. Since a CCB like
Place the lifestyle modifications of weight reduction, moderation of alcohol consumption, and
physical activity in order of the decrease in expected/approximate systolic blood pressure reduction.
Start with the lowest expected decrease in SBP.
A
, Moderation of alcohol consumption, physical activity, weight reduction
B
Weight reduction, physical activity, moderation of alcohol consumption
C
Physical activity, moderation of alcohol consumption, weight reduction - Answer a is correct.
Moderation of alcohol consumption has an approximate range of a 2 to 4 mm Hg decrease in SBP.
Physical activity has an approximate range of 4 to 9 mm Hg decrease in SBP. Weight reduction has an
approximate range of 5 to 20 mm Hg per 10 kg decrease in SBP.
Answers b and c are incorrect. Those answers are not the correct ordered response of blood pressure
reduction starting with the lowest expected decrease in SBP.
According to the 2017 guidelines for hypertension, what is the BP goal for a 58-year-old African
American male with diabetes and chronic kidney disease?
A
<130/80 mm Hg
B
<140/90 mm Hg
C
<150/90 mm Hg
D
<160/100 mm Hg - Answer a is correct. All patients with hypertension and cardiovascular disease or
other comorbid conditions such as CKD and diabetes should have a goal blood pressure of <130/80
mm Hg.
Answers b, c, d are incorrect. For adults with confirmed hypertension and known stable CVD or
≥10% 10-year ASCVD risk, a BP target of <130/80 mm Hg is recommended. BP should be
categorized as normal, elevated, or stages 1 or 2 hypertension to prevent and treat high BP. Normal
BP is defined as <120/<80 mm Hg; elevated BP 120-129/<80 mm Hg; hypertension stage 1 is 130-
139 or 80-89 mm Hg, and hypertension stage 2 is ≥140 or ≥90 mm Hg. Prior to labeling a person with
