Abfm Hypertension Exam Latest Updated
2025 With Well Elaborated Questions And Detailed
Answers Graded A+
A 47-year-old African-American female with a 5-year history of type 2 diabetes is
diagnosed with hypertension. A physical examination is notable only for a blood
pressure of 144/88 mm Hg. Laboratory findings include a hemoglobin A1c of 6.7%, a
normal serum creatinine level, and the absence of albuminuria.Both the JNC 8 panel
and the 2017 American College of Cardiology/American Heart Association guidelines
recommend which one of the following drug classes as initial therapy for patients such
as this?
ACE inhibitors
Angiotensin receptor blockers
β-Blockers
Calcium channel blockers
Loop diuretics - ANSWERS-D
When used as monotherapy, thiazide diuretics and calcium channel blockers have been
found to be more effective for reducing blood pressure in African-American patients
than β-blockers, ACE inhibitors, or angiotensin receptor blockers. The Antihypertensive
and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found thiazide
diuretics to be more effective than ACE inhibitors for improving heart failure and
cardiovascular outcomes in African-American patients. Calcium channel blockers have
been found to be more effective than ACE inhibitors for reducing stroke in these
patients.JNC 8 recommends that for the general African-American population, including
those with diabetes mellitus, initial antihypertensive treatment should include a thiazide-
type diuretic or a calcium channel blocker (SOR B). The 2017 American College of
Cardiology/American Heart Association hypertension guidelines similarly recommend
either a thiazide diuretic or a calcium channel blocker as first-line therapy in African-
American adults without heart failure or chronic kidney disease.
You suspect the possibility of pheochromocytoma in a 39-year-male with extremely
labile blood pressure readings and a history of episodic headaches, palpitations,
sweating, and orthostatic dizziness. Which one of the following is the most sensitive
laboratory test for detecting pheochromocytoma?
A plasma catecholamine level
A plasma metanephrine level
24-hour urine for catecholamines
24-hour urine for metanephrines
24-hour urine for vanillylmandelic acid - ANSWERS-B
,Plasma metanephrines have a sensitivity of 97% for pheochromocytoma, which is
significantly higher than the sensitivity of other measurements. This diagnostic accuracy
has been confirmed by at least 15 separate studies. One comparison placed the
sensitivity of other tests in the range of 47%-74%.
Which one of the following interventions has the greatest potential impact for lowering
systolic blood pressure in a patient with hypertension?
Limiting alcohol consumption
Reducing sodium intake to 2400 mg daily
Following the Dietary Approaches to Stop Hypertension (DASH) diet
Calcium supplementation
Regular aerobic exercise for 30 min daily, 5-6 days/week - ANSWERS-C
A 39-year-old male sees you for evaluation of high blood pressure. His past medical
history is unremarkable. On examination he has a BMI of 32 kg/m2 and you note that he
has a round face and a plethoric complexion. His blood pressure is 150/98 mm Hg, his
pulse rate is 88 beats/min, and his respiratory rate is 16/min. Other notable findings
include a prominent dorsal cervical fat pad and supraclavicular fat pads, as well as
violaceous striae on his trunk. Laboratory findings are notable only for a fasting glucose
level of 114 mg/dL.Which one of the following is the most likely cause of his
hypertension?
Addison's disease
Cushing syndrome
Hemochromatosis
Pheochromocytoma
Primary hyperaldosteronism - ANSWERS-B
This patient's clinical findings are consistent with Cushing syndrome, or
hyperadrenocorticism. This is a clinical syndrome and metabolic disorder resulting from
chronic excess of glucocorticoids. The most common cause is corticosteroid use, but
adrenal neoplasms account for 20%-25% of cases. Findings include general weakness,
osteoporosis, moon facies, facial plethora, ecchymoses, truncal obesity, violaceous
striae of the abdomen, deposition of adipose tissue in the interscapular area ("buffalo
hump"), and glucose intolerance.
You diagnose stage 2 hypertension in a 54-year-old male. His past medical history is
otherwise unremarkable and a physical examination is notable for mild AV nicking on
funduscopic examination. A baseline EKG reveals evidence of left ventricular
hypertrophy.Which one of the following classes of antihypertensive agents has NOT
been shown to produce a regression of left ventricular hypertrophy?
ACE inhibitors
β-Blockers
Calcium channel blockers
Direct vasodilators
,Thiazide diuretics - ANSWERS-D
In patients with left ventricular hypertrophy, studies have shown a reduction in left
ventricular mass in those treated with ACE inhibitors, diuretics, calcium channel
blockers, and β-blockers, with the most consistent reduction achieved with ACE
inhibitors and the least with β-blockers. Regression of left ventricular hypertrophy has
not been demonstrated with direct vasodilators such as hydralazine and minoxidil.
According to currently accepted criteria, hypertension in children is defined as repeated
blood pressure measurements at or above a threshold of which one of the following
percentiles for age, sex, and height?
80th
85th
90th
95th
99th - ANSWERS-D
In children and adolescents, hypertension is defined as blood pressure at or above the
95th percentile for age, sex, and height, on repeated measurements.
Which one of the following conditions is associated with isolated systolic hypertension?
Aortic stenosis
Hypothyroidism
Paget's disease
Renovascular hypertension
Severe osteoporosis - ANSWERS-C
Isolated elevation of systolic blood pressure can be secondary to conditions associated
with elevated cardiac output, such as anemia, Paget's disease, hyperthyroidism,
arteriovenous fistula, and aortic insufficiency.
A 59-year-old African-American male with a history of hypercholesterolemia and gout
sees you for a health maintenance visit. A physical examination is notable only for a
blood pressure of 144/85 mm Hg.Laboratory FindingsLDL-cholesterol............82
mg/dLHDL-cholesterol............47 mg/dLSerum triglycerides............134 mg/dLLiver
panel............normalSerum creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular
filtration rate............56 mL/min/1.73 m2Which one of the following does the JNC 8 panel
recommend as initial management of this patient's blood pressure elevation?
Lifestyle measures only
An ACE inhibitor
A calcium channel blocker
Hydralazine
Hydrochlorothiazide - ANSWERS-B
, The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood
pressure in patients ≥18 years of age with a systolic blood pressure ≥140 mm Hg or a
diastolic blood pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined
as an estimated or measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2.
Treatment is recommended for patients of any age with these blood pressure values
who also have albuminuria, defined as >30 mg of albumin/g of creatinine regardless of
GFR (SOR C).Although a thiazide diuretic or a calcium channel blocker is generally
recommended as first-line antihypertensive therapy in African-Americans, for patients
≥18 years of age who have CKD, the JNC 8 panel recommends initial (or add-on)
antihypertensive treatment with an ACE inhibitor or angiotensin receptor blocker to
improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The 2017
American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in
patients who have stages 1 or 2 CKD with albuminuria >300 mg/day.
A 67-year-old male with a history of hypertension and type 2 diabetes has inadequately
controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril), 40 mg
daily; hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage
XR), 1500 mg daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal
serum electrolytes, a serum creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary
albumin/creatinine ratio of 80 mg/g (N <30).Which one of the following agents should be
AVOIDED in this patient?
Aliskiren (Tekturna)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
Felodipine (Plendil) - ANSWERS-A
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints)
was a randomized, double-blind, placebo-controlled international multicenter trial
undertaken to determine whether the addition of the direct renin inhibitor aliskiren to
standard therapy with renin-angiotensin system blockade would be beneficial for
patients with type 2 diabetes who are at high risk for cardiovascular and renal events.
The study was terminated prematurely after a median follow-up of 27 months when no
benefit was apparent, and a higher risk of hyperkalemia and hypotension was seen in
patients receiving aliskiren. Based on this study, the FDA issued a drug safety warning
in 2012 that announced two additions to the drug labeling of aliskiren-containing
products. The first addition was a contraindication to the use of aliskiren in patients with
diabetes mellitus who are taking angiotensin receptor blockers (ARBs) or ACE
inhibitors, because of an increased risk of renal impairment, hypotension, and
hyperkalemia. The second addition was a warning to avoid the use of aliskiren with
ARBs or ACE inhibitors in patients with moderate to severe renal impairment
(glomerular filtration rate <60 mL/min/1.73 m2).The use of ACE inhibitors, ARBs, β-
blockers, diuretics, and calcium channel blockers has been shown to be effective in
reducing cardiovascular events in patients with diabetes mellitus. Although no such
2025 With Well Elaborated Questions And Detailed
Answers Graded A+
A 47-year-old African-American female with a 5-year history of type 2 diabetes is
diagnosed with hypertension. A physical examination is notable only for a blood
pressure of 144/88 mm Hg. Laboratory findings include a hemoglobin A1c of 6.7%, a
normal serum creatinine level, and the absence of albuminuria.Both the JNC 8 panel
and the 2017 American College of Cardiology/American Heart Association guidelines
recommend which one of the following drug classes as initial therapy for patients such
as this?
ACE inhibitors
Angiotensin receptor blockers
β-Blockers
Calcium channel blockers
Loop diuretics - ANSWERS-D
When used as monotherapy, thiazide diuretics and calcium channel blockers have been
found to be more effective for reducing blood pressure in African-American patients
than β-blockers, ACE inhibitors, or angiotensin receptor blockers. The Antihypertensive
and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found thiazide
diuretics to be more effective than ACE inhibitors for improving heart failure and
cardiovascular outcomes in African-American patients. Calcium channel blockers have
been found to be more effective than ACE inhibitors for reducing stroke in these
patients.JNC 8 recommends that for the general African-American population, including
those with diabetes mellitus, initial antihypertensive treatment should include a thiazide-
type diuretic or a calcium channel blocker (SOR B). The 2017 American College of
Cardiology/American Heart Association hypertension guidelines similarly recommend
either a thiazide diuretic or a calcium channel blocker as first-line therapy in African-
American adults without heart failure or chronic kidney disease.
You suspect the possibility of pheochromocytoma in a 39-year-male with extremely
labile blood pressure readings and a history of episodic headaches, palpitations,
sweating, and orthostatic dizziness. Which one of the following is the most sensitive
laboratory test for detecting pheochromocytoma?
A plasma catecholamine level
A plasma metanephrine level
24-hour urine for catecholamines
24-hour urine for metanephrines
24-hour urine for vanillylmandelic acid - ANSWERS-B
,Plasma metanephrines have a sensitivity of 97% for pheochromocytoma, which is
significantly higher than the sensitivity of other measurements. This diagnostic accuracy
has been confirmed by at least 15 separate studies. One comparison placed the
sensitivity of other tests in the range of 47%-74%.
Which one of the following interventions has the greatest potential impact for lowering
systolic blood pressure in a patient with hypertension?
Limiting alcohol consumption
Reducing sodium intake to 2400 mg daily
Following the Dietary Approaches to Stop Hypertension (DASH) diet
Calcium supplementation
Regular aerobic exercise for 30 min daily, 5-6 days/week - ANSWERS-C
A 39-year-old male sees you for evaluation of high blood pressure. His past medical
history is unremarkable. On examination he has a BMI of 32 kg/m2 and you note that he
has a round face and a plethoric complexion. His blood pressure is 150/98 mm Hg, his
pulse rate is 88 beats/min, and his respiratory rate is 16/min. Other notable findings
include a prominent dorsal cervical fat pad and supraclavicular fat pads, as well as
violaceous striae on his trunk. Laboratory findings are notable only for a fasting glucose
level of 114 mg/dL.Which one of the following is the most likely cause of his
hypertension?
Addison's disease
Cushing syndrome
Hemochromatosis
Pheochromocytoma
Primary hyperaldosteronism - ANSWERS-B
This patient's clinical findings are consistent with Cushing syndrome, or
hyperadrenocorticism. This is a clinical syndrome and metabolic disorder resulting from
chronic excess of glucocorticoids. The most common cause is corticosteroid use, but
adrenal neoplasms account for 20%-25% of cases. Findings include general weakness,
osteoporosis, moon facies, facial plethora, ecchymoses, truncal obesity, violaceous
striae of the abdomen, deposition of adipose tissue in the interscapular area ("buffalo
hump"), and glucose intolerance.
You diagnose stage 2 hypertension in a 54-year-old male. His past medical history is
otherwise unremarkable and a physical examination is notable for mild AV nicking on
funduscopic examination. A baseline EKG reveals evidence of left ventricular
hypertrophy.Which one of the following classes of antihypertensive agents has NOT
been shown to produce a regression of left ventricular hypertrophy?
ACE inhibitors
β-Blockers
Calcium channel blockers
Direct vasodilators
,Thiazide diuretics - ANSWERS-D
In patients with left ventricular hypertrophy, studies have shown a reduction in left
ventricular mass in those treated with ACE inhibitors, diuretics, calcium channel
blockers, and β-blockers, with the most consistent reduction achieved with ACE
inhibitors and the least with β-blockers. Regression of left ventricular hypertrophy has
not been demonstrated with direct vasodilators such as hydralazine and minoxidil.
According to currently accepted criteria, hypertension in children is defined as repeated
blood pressure measurements at or above a threshold of which one of the following
percentiles for age, sex, and height?
80th
85th
90th
95th
99th - ANSWERS-D
In children and adolescents, hypertension is defined as blood pressure at or above the
95th percentile for age, sex, and height, on repeated measurements.
Which one of the following conditions is associated with isolated systolic hypertension?
Aortic stenosis
Hypothyroidism
Paget's disease
Renovascular hypertension
Severe osteoporosis - ANSWERS-C
Isolated elevation of systolic blood pressure can be secondary to conditions associated
with elevated cardiac output, such as anemia, Paget's disease, hyperthyroidism,
arteriovenous fistula, and aortic insufficiency.
A 59-year-old African-American male with a history of hypercholesterolemia and gout
sees you for a health maintenance visit. A physical examination is notable only for a
blood pressure of 144/85 mm Hg.Laboratory FindingsLDL-cholesterol............82
mg/dLHDL-cholesterol............47 mg/dLSerum triglycerides............134 mg/dLLiver
panel............normalSerum creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular
filtration rate............56 mL/min/1.73 m2Which one of the following does the JNC 8 panel
recommend as initial management of this patient's blood pressure elevation?
Lifestyle measures only
An ACE inhibitor
A calcium channel blocker
Hydralazine
Hydrochlorothiazide - ANSWERS-B
, The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood
pressure in patients ≥18 years of age with a systolic blood pressure ≥140 mm Hg or a
diastolic blood pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined
as an estimated or measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2.
Treatment is recommended for patients of any age with these blood pressure values
who also have albuminuria, defined as >30 mg of albumin/g of creatinine regardless of
GFR (SOR C).Although a thiazide diuretic or a calcium channel blocker is generally
recommended as first-line antihypertensive therapy in African-Americans, for patients
≥18 years of age who have CKD, the JNC 8 panel recommends initial (or add-on)
antihypertensive treatment with an ACE inhibitor or angiotensin receptor blocker to
improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The 2017
American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in
patients who have stages 1 or 2 CKD with albuminuria >300 mg/day.
A 67-year-old male with a history of hypertension and type 2 diabetes has inadequately
controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril), 40 mg
daily; hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage
XR), 1500 mg daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal
serum electrolytes, a serum creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary
albumin/creatinine ratio of 80 mg/g (N <30).Which one of the following agents should be
AVOIDED in this patient?
Aliskiren (Tekturna)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
Felodipine (Plendil) - ANSWERS-A
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints)
was a randomized, double-blind, placebo-controlled international multicenter trial
undertaken to determine whether the addition of the direct renin inhibitor aliskiren to
standard therapy with renin-angiotensin system blockade would be beneficial for
patients with type 2 diabetes who are at high risk for cardiovascular and renal events.
The study was terminated prematurely after a median follow-up of 27 months when no
benefit was apparent, and a higher risk of hyperkalemia and hypotension was seen in
patients receiving aliskiren. Based on this study, the FDA issued a drug safety warning
in 2012 that announced two additions to the drug labeling of aliskiren-containing
products. The first addition was a contraindication to the use of aliskiren in patients with
diabetes mellitus who are taking angiotensin receptor blockers (ARBs) or ACE
inhibitors, because of an increased risk of renal impairment, hypotension, and
hyperkalemia. The second addition was a warning to avoid the use of aliskiren with
ARBs or ACE inhibitors in patients with moderate to severe renal impairment
(glomerular filtration rate <60 mL/min/1.73 m2).The use of ACE inhibitors, ARBs, β-
blockers, diuretics, and calcium channel blockers has been shown to be effective in
reducing cardiovascular events in patients with diabetes mellitus. Although no such
