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ABFM |\HYPERTENSION |\EXAM |\
QUESTIONS |\WITH |\ANSWERS
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 |- |\CORRECT |\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 |- |\CORRECT |\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
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 |- |\CORRECT |\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) |- |\CORRECT |\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, |\
investigating |\fenoldopam |\use |\in |\severe |\hypertension, |\its |\efficacy |
in |\lowering |\blood |\pressure |\was |\found |\to |\be |\comparable |\to |\that |\of |\nitroprusside. |\It |\is |\FDA-approved |\for |\the |\in-hospital |\management |\of |\severe |\hypertension |\when |\rapid |\but |\quickly |\reversible |
reduction |\of |\blood |\pressure |\is |\required, |\such |\as |\in |\a |\patient |\with |
malignant |\hypertension |\who |\has |\deteriorating |\end-organ |
function. |\By |\virtue |\of |\its |\actions |\on |\peripheral |\dopamine |
receptors, |\fenoldopam |\produces |\renal |\arterial |\vasodilation |\and |
natriuresis, |\and |\thus |\can |\provide |\a |\renal |\protective |\effect |\in |
clinical |\situations |\associated |\with |\impaired |\renal |\function. |\In |
addition, |\there |\is |\evidence |\that |\it |\may |\improve |\creatinine |
clearance |\and |\urine |\flow |\rates |\in |\severely |\hypertensive |\patients |
with |\either |\normal |\or |\impaired |\renal |\function. |\The |\ 2017 |\American |\College |\of |\Cardiology/American |\Heart |\Association |(ACC/AHA) |
hypertension |\guidelines |\include |\fenoldopam |\as |\a |\preferred |\agent |
for |\treating |\hypertensive |\emergencies |\associated |\with |\acute |
renal |\failure. |\Other |\options |\include |\nicardipine |\and |\clevidipine. Compared |\to |\the |\typical |\American |\diet, |\the |\Dietary |\Approaches |
to |\Stop |\Hypertension |(DASH) |\diet |\includes |\reduced |\consumption |
of |\which |\one |\of |\the |\following? Dietary |\fiber Dietary |\protein Low-fat |\dairy |\products Nuts |\and |\whole |\grains Fats |\and |\sweets |- |\CORRECT |\ANSWERS |\✔✔E Compared |\to |\a |\control |\diet |\with |\a |\high |\sodium |\level, |\the |\low- sodium |\Dietary |\Approaches |\to |\Stop |\Hypertension |(DASH) |\diet |
was |\found |\to |\lower |\mean |\systolic |\blood |\pressure |\7.1 |\mm |\Hg |\in |\
participants |\without |\hypertension |\and |\11.5 |\mm |\Hg |\in |\participants |\with |\hypertension. |\The |\DASH |\diet |\emphasizes |\fruits, |\vegetables, |
and |\low-fat |\dairy |\foods, |\and |\includes |\whole |\grains, |\poultry, |\fish, |
and |\nuts, |\and |\contains |\smaller |\amounts |\of |\red |\meats, |\sweets, |
and |\sugar-containing |\beverages |\than |\the |\typical |\American |\diet. |\It |\also |\provides |\smaller |\amounts |\of |\cholesterol |\and |\total |\and |
saturated |\fat, |\and |\larger |\amounts |\of |\potassium, |\dietary |\fiber, |\and |\protein. An |\obese |\64-year-old |\female |\with |\a |\history |\of |
hypercholesterolemia |\has |\a |\blood |\pressure |\of |\168/102 |\mm |\Hg |
and |\is |\started |\on |\hydrochlorothiazide |\and |\amlodipine |(Norvasc). |
For |\patients |\such |\as |\this, |\the |\ 2017 |\treatment |\guidelines |\jointly |
developed |\by |\the |\American |\Academy |\of |\Family |\Physicians |\and |
the |\American |\College |\of |\Physicians |\recommend |\a |\target |\systolic |
blood |\pressure |\of |\less |\than 160 |\mm |\Hg 150 |\mm |\Hg 140 |\mm |\Hg 135 |\mm |\Hg 130 |\mm |\Hg |- |\CORRECT |\ANSWERS |\✔✔B The |\target |\blood |\pressure |\for |\older |\patients |\continues |\to |\be |\an |
area |\of |\controversy, |\particularly |\as |\it |\relates |\to |\systolic |\blood |
pressure |(SBP). |\Although |\a |\target |\blood |\pressure |\of |<140/90 |\mm |
Hg |\was |\generally |\favored |\in |\the |\past, |\the |\JNC |\ 8 |\panel |\found |
insufficient |\evidence |\to |\conclude |\that |\a |\goal |\SBP |\of |<140 |\mm |\Hg |\in |\patients |\age |\ 60 |\or |\over |\provided |\additional |\benefit |\compared |
with |\a |\goal |\SBP |\of |<140-160 |\mm |\Hg |\or |<140-149 |\mm |\Hg. |
Accordingly, |\the |\JNC |\ 8 |\panel |\recommends |\a |\goal |\SBP |\of |<150 |\
ACE |\inhibitors Angiotensin |\receptor |\blockers β-Blockers Calcium |\channel |\blockers Loop |\diuretics |- |\CORRECT |\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 |- |\CORRECT |\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 |- |
CORRECT |\ANSWERS |\✔✔C The |\Dietary |\Approaches |\to |\Stop |\Hypertension |(DASH) |\diet |\is |\rich |
in |\fruits, |\vegetables, |\whole |\grains, |\and |\low-fat |\dairy |\products, |\
A |\61-year-old |\female |\sees |\you |\for |\follow-up |\after |\a |\routine |\health |\maintenance |\examination. |\Her |\blood |\pressure |\at |\that |\visit |\was |
132/84 |\mm |\Hg, |\and |\a |\follow-up |\measurement |\was |\134/82 |\mm |
Hg.Based |\on |\current |\American |\College |\of |\Cardiology/American |
Heart |\Association |\guidelines, |\her |\blood |\pressure |\would |\be |
categorized |\as normal elevated prehypertension stage |\ 1 |\hypertension masked |\hypertension |- |\CORRECT |\ANSWERS |\✔✔D JNC |\ 7 |\introduced |\the |\new |\blood |\pressure |\category |\of |
prehypertension |\for |\patients |\with |\a |\systolic |\blood |\pressure |(SBP) |
of |\120-139 |\mm |\Hg |\and/or |\a |\diastolic |\blood |\pressure |(DBP) |\of |\80- 89 |\mm |\Hg. |\The |\ 2017 |\American |\College |\of |\Cardiology/American |
Heart |\Association |(ACC/AHA) |\guidelines |\eliminated |\this |\term |\and |
divided |\blood |\pressure |\into |\four |\categories: Normal |\blood |\pressure: |\SBP |<120 |\mm |\Hg |\and |\DBP |<80 |\mm |\Hg Elevated |\blood |\pressure: |\SBP |\120-129 |\mm |\Hg |\and |\DBP |<80 |\mm |
Hg Stage |\ 1 |\hypertension: |\SBP |\130-139 |\or |\DBP |\80-89 |\mm |\Hg Stage |\ 2 |\hypertension: |\SBP |>140 |\mm |\Hg |\or |\DBP |>90 |\mm |\Hg The |\term |\masked |\hypertension |\is |\used |\for |\patients |\found |\to |
consistently |\have |\hypertensive |\blood |\pressure |\readings |\at |\home |
or |\in |\nonhealthcare |\settings, |\or |\with |\ambulatory |\blood |\pressure |
monitoring, |\with |\consistently |\normal |\blood |\pressure |\readings |\in |
the |\office |\or |\clinic |\setting.Although |\JNC |\ 7 |\did |\not |\recommend |\
antihypertensive |\drug |\therapy |\for |\patients |\who |\continued |\to |
have |\prehypertension |\despite |\a |\trial |\of |\lifestyle |\modification, |\the |
2017 |\ACC/AHA |\guidelines |\recommend |\drug |\therapy |\for |\those |
adults |\with |\stage |\ 1 |\hypertension |\found |\to |\have |\an |\estimated |\10- year |\atherosclerotic |\cardiovascular |\disease |\risk |\score |\≥10%. Which |\one |\of |\the |\following |\is |\most |\appropriate |\for |\initiating |\drug |
therapy |\for |\hypertension |\during |\pregnancy? Atenolol |(Tenormin) Enalapril |(Vasotec) Hydrochlorothiazide Labetalol |(Trandate) Losartan |(Cozaar) |- |\CORRECT |\ANSWERS |\✔✔D Antihypertensive |\therapy |\during |\pregnancy |\should |\be |\prescribed |
only |\for |\maternal |\safety, |\since |\it |\does |\not |\improve |\perinatal |
outcomes |\and |\may |\adversely |\affect |\uteroplacental |\blood |\flow. |
The |\ 2017 |\American |\College |\of |\Cardiology/American |\Heart |
Association |\hypertension |\guidelines |\recommend |\that |\pregnant |
women |\or |\women |\who |\plan |\to |\become |\pregnant |\be |\transitioned |
to |\methyldopa, |\nifedipine, |\and/or |\labetalol |(SOR |\C). |\ACE |
inhibitors |\and |\angiotensin |\receptor |\blockers |\are |\fetotoxic |\and |\are |\contraindicated |\during |\pregnancy. |\Atenolol |\has |\been |\associated |
with |\intrauterine |\growth |\retardation, |\as |\well |\as |\decreased |
placental |\growth |\and |\weight |\when |\taken |\during |\pregnancy. |
Although |\regarded |\in |\JNC |\ 7 |\as |\probably |\safe, |\thiazide |\diuretics |
are |\not |\recommended |\as |\first-line |\therapy.
pheochromocytoma |\should |\be |\suspected. |\Furthermore, |\the |
Hypertension |\Canada |\ 2017 |\guidelines |\recommend |\that |\the |
possibility |\of |\pheochromocytoma |\be |\considered |\in |\patients |\with |
hypertension |\triggered |\by |\β-blockers |\as |\well |\by |\monoamine |
oxidase |\inhibitors, |\micturition, |\changes |\in |\abdominal |\pressure, |
surgery, |\or |\anesthesia. Which |\one |\of |\the |\following |\is |\recommended |\for |\the |\primary |
prevention |\of |\hypertension |\and |\has |\also |\been |\shown |\to |
significantly |\lower |\blood |\pressure |\in |\patients |\who |\have |
hypertension? Increased |\potassium |\intake Fish |\oil |\supplements Calcium |\supplements Relaxation |\therapies Acupuncture |- |\CORRECT |\ANSWERS |\✔✔A Potassium |\intake |\appears |\to |\be |\inversely |\proportional |\to |\blood |
pressure |\and |\the |\risk |\of |\stroke. |\A |\higher |\level |\of |\potassium |
appears |\to |\reduce |\salt |\sensitivity |\and |\blunt |\the |\effect |\of |\salt |\on |
blood |\pressure. |\Potassium, |\preferably |\dietary, |\is |\recommended |\in |\the |\ 2017 |\American |\College |\of |\Cardiology/American |\Heart |
Association |(ACC/AHA) |\guidelines |\as |\a |\nonpharmacologic |
measure |\for |\reducing |\blood |\pressure.Although |\adequate |\calcium |
intake |\and |\fish |\oil |\supplements |\may |\be |\important |\for |\general |
health, |\the |\effect |\of |\these |\lifestyle |\modifications |\on |\blood |
pressure |\is |\too |\small |\to |\support |\recommending |\them |\for |\the |
primary |\prevention |\of |\hypertension. |\The |\AHA |\has |\determined |
that |\there |\is |\currently |\insufficient |\evidence |\to |\recommend |
relaxation |\therapies |\or |\acupuncture |\to |\reduce |\blood |\pressure.
A |\nonthiazide |\diuretic |\should |\be |\considered |\for |\initial |
antihypertensive |\therapy |\in |\patients |\with |\which |\one |\of |\the |
following? Diabetes |\mellitus Recurrent |\calcium |\kidney |\stones Stage |\ 3 |\chronic |\kidney |\disease, |\with |\an |\estimated |\glomerular |
filtration |\rate |\of |\ 50 |\mL/min/1.73 |\m Bipolar |\disorder |\treated |\with |\lithium A |\past |\history |\of |\stroke |- |\CORRECT |\ANSWERS |\✔✔D Diuretic-induced |\sodium |\loss |\can |\reduce |\the |\renal |\clearance |\of |
lithium, |\thereby |\increasing |\serum |\lithium |\levels |\and |\the |\risk |\of |
lithium |\toxicity. |\In |\addition, |\by |\reducing |\urine |\calcium |\excretion, |
thiazide-type |\diuretics |\have |\been |\shown |\to |\significantly |\reduce |
recurrence |\rates |\of |\calcium |\stones |\by |\up |\to |\50% |\over |\a |\3-year |
period. |\Thiazide |\diuretics |\are |\generally |\thought |\to |\be |\less |
effective |\in |\patients |\with |\moderate |\to |\severe |\chronic |\kidney |
disease |(CKD). |\The |\ 2017 |\American |\College |\of |\Cardiology/American |\Heart |\Association |\guidelines |\favor |\the |\use |
of |\loop |\diuretics |\over |\thiazide |\diuretics |\in |\patients |\with |\stage |\ 4 |
CKD |\with |\a |\glomerular |\filtration |\rate |<30 |\mL/min/1.73 |\m2. |
Thiazide-type |\diuretics |\have |\been |\shown |\to |\improve |\clinical |
outcomes |\in |\patients |\with |\diabetes |\mellitus, |\as |\well |\as |\following |
a |\stroke. Which |\one |\of |\the |\following |\is |\lower |\in |\women |\compared |\to |\men? The |\prevalence |\of |\hypertension |\after |\ 60 |\years |\of |\age
Average |\readings |\of |\128/80 |\mm |\Hg |\during |\the |\day, |\with |\a |\low |
reading |\of |\88/50 |\mm |\Hg |\at |\ 8 |\a.m., |\ 2 |\hours |\after |\she |\takes |\her |
medications A |\peak |\blood |\pressure |\reading |\of |\170/85 |\mm |\Hg |\during |\a |\walk |\at |\ 3 |\p.m. Average |\readings |\of |\135/85 |\mm |\Hg |\during |\the |\day |\and |\130/80 |
mm |\Hg |\during |\the |\night Average |\readings |\of |\135/85 |\mm |\Hg |\during |\the |\day |\and |\115/70 |
mm |\Hg |\during |\the |\night Average |\readings |\of |\140/90 |\mm |\Hg |\during |\the |\day |\and |\120/80 |- |
CORRECT |\ANSWERS |\✔✔C This |\patient |\appears |\to |\have |\at |\least |\a |\component |\of |\white |\coat |
hypertension, |\which |\can |\be |\difficult |\to |\assess. |\White |\coat |
hypertension |\can |\account |\for |\up |\to |\30%-40% |\of |\people |\with |
elevated |\office |\blood |\pressures, |\and |>50% |\of |\cases |\in |\the |\very |
old. |\It |\is |\more |\common |\in |\older |\adults, |\women, |\and |\nonsmokers. |
Home |\blood |\pressure |\monitoring |\and |\ambulatory |\blood |\pressure |
monitoring |(ABPM) |\are |\generally |\needed |\to |\further |\assess |\these |
patients. |\ABPM |\values |\are, |\on |\average, |\lower |\than |\office |\blood |
pressure |\values, |\and |\the |\diagnostic |\threshold |\for |\hypertension |
should |\be |\adjusted |\downward, |\as |\the |\threshold |\blood |\pressure |
for |\a |\hypertension |\diagnosis |\is |>130/80 |\mm |\Hg |\over |\ 24 |\hours, |\
135/85 |\mm |\Hg |\for |\the |\daytime |\average, |\and |>120/70 |\mm |\Hg |
for |\the |\nighttime |\average.A |\24-hour |\ABPM |\is |\a |\better |\predictor |\of |\hypertension-mediated |\organ |\damage |\and |\cardiovascular |\risk |
than |\office |\blood |\pressure. |\Nighttime |\ambulatory |\blood |\pressure |
readings |\are |\important |\for |\assessing |\cardiovascular |\risk |\in |
patients |\with |\hypertension, |\as |\blood |\pressure |\normally |\decreases |\during |\sleep. |\Studies |\that |\accounted |\for |\daytime |\and |\nighttime |
blood |\pressure |\in |\the |\same |\statistical |\model |\found |\that |\nighttime |\blood |\pressure |\is |\a |\stronger |\predictor |\of |\poor |\outcomes |\than |\
daytime |\blood |\pressure. |\Although |\the |\degree |\of |\nighttime |\blood |
pressure |\lowering |\has |\a |\normal |\distribution |\in |\a |\population |
setting, |\an |\arbitrary |\cut-off |\has |\been |\proposed |\to |\define |\patients |
as |"dippers" |\if |\their |\blood |\pressure |\falls |\at |\night |\by |>10% |\of |\the |
daytime |\average. |\The |\night-to-day |\ratio |\is |\an |\important |\predictor |\of |\outcomes, |\with |\those |\who |\dip |<10% |\having |\an |\increased |
cardiovascular |\risk |\and |\those |\with |\no |\nighttime |\dip |\having |\a |
substantial |\increase |\in |\risk. |\Extreme |\dipping |\also |\appears |\to |
confer |\increased |\risk, |\but |\the |\limited |\prevalence |\of |\this |\event |
makes |\it |\difficult |\to |\make |\definitive |\ri A |\62-year-old |\female |\is |\diagnosed |\with |\stage |\ 1 |\hypertension. |\Her |\10-year |\American |\Heart |\Association |\cardiovascular |\risk |\score |\is |
calculated |\at |\8.8%. |\You |\recommend |\that |\she |\begin |\an |\exercise |
program |\and |\she |\asks |\how |\much |\benefit |\she |\could |\expect.Which |
one |\of |\the |\following |\statements |\is |\true |\regarding |\the |\effect |\of |
aerobic |\exercise |\on |\blood |\pressure? Aerobic |\exercise |\reduces |\blood |\pressure |\in |\patients |\with |
hypertension |\but |\not |\in |\patients |\with |\normal |\blood |\pressure Aerobic |\exercise |\has |\been |\shown |\to |\lower |\systolic |\blood |\pressure |\by |\10-15 |\mm |\Hg |\in |\patients |\with |\hypertension Aerobic |\exercise |\has |\been |\shown |\to |\reduce |\insulin |\resistance |\in |
patients |\with |\hypertension A |\blood |\pressure |\lowering |\effect |\is |\not |\seen |\with |\dynamic |
resistance |\training Sedentary |\individuals |\have |\a |\10%-20% |\higher |\risk |\of |\developing |
hypertension |\compared |\to |\those |\who |\exercise |\regularly |- |
CORRECT |\ANSWERS |\✔✔C
