ABFM Hypertension Exam: Questions & Answers: Updated Solution

Which one of the following interventions is recommended by the 2017 American College of Cardiology/American Heart Association guidelines for the nonpharmacologic management of hypertension? Reducing sodium consumption by 1000 mg daily Avoiding isometric exercise Avoiding caffeine consumption Avoiding alcohol use (Ans- A Weight reduction and dietary sodium reduction have been associated with a reduction in systolic blood pressure of 5-20 mm Hg and 2-8 mm Hg, respectively. Although the optimal goal for sodium consumption is ≤1500 mg daily, the American Heart Association recommends aiming for a reduction of at least 1000 mg daily in most adults.Although there is no evidence that long-term use of coffee is associated with increased blood pressure, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines recommend that caffeine intake be limited to <300 mg daily. Limited consumption of alcohol (two drinks per day in men and one drink per day in women) may lower systolic blood pressure by 2-4 mm Hg. Dynamic aerobic exercise and resistance training have been shown to provide a blood pressure-lowering effect. Meta-analyses suggest that isometric exercise also results in substantial lowering of blood pressure, and isometric exercise is recommended in the 2017 ACC/AHA guidelines. Which one of the following would be an appropriate choice for initial imaging in a patient with suspected renovascular hypertension?Duplex Doppler flow studies of the renal arteries Rapid-sequence intravenous pyelography Renal artery angiography Captopril renography (Ans- A In a hypertensive patient with suspected renovascular hypertension, appropriate noninvasive imaging choices include duplex Doppler flow studies, CT angiography, and magnetic resonance angiography (MRA). Although intravenous pyelography was a standard test for renovascular hypertension in the past, it is no longer favored because of unacceptable false-positive and false-negative rates.The diagnostic accuracy of captopril renography is inferior to MRA and duplex Doppler flow studies, particularly in patients with chronic kidney disease and bilateral atherosclerotic renal artery stenosis. While renal artery angiography remains the gold standard for identifying the anatomy of the renal artery, it is an invasive procedure with some associated risk, and is not recommended for the sole purpose of diagnosing renovascular hypertension.