ABFM HYPERTENSION QUESTIONS & ANSWERS
2023 ( A+ GRADED 100% VERIFIED)
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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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) - ANSWER 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 benefit has been seen with doxazosin, there is no
contraindication to its use in patients with diabetes.
A 44-year-old male has a 1-week history of generalized headaches and nonspecific
dizziness. His past medical history is notable only for a 3-year history of
hypertension, which has been poorly controlled because of a lack of adherence to
his drug regimen. His renal status was normal 1 month ago. On examination his
blood pressure is 250/150 mm Hg, and you note cotton-wool exudates on
funduscopic examination. Laboratory evaluation reveals normal serum electrolytes, a
serum creatinine level of 3.8 mg/dL (N 0.7-1.3), and a BUN level of 60 mg/dL (N 6-
20). A urinalysis shows gross hematuria and 3+ proteinuria.Which one of the
following will rapidly lower his blood pressure and increase renal blood flow?
Diazoxide (Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam (Corlopam)
Nitroprusside (Nitropress) - ANSWER D
, Fenoldopam is a selective peripheral dopamine-receptor agonist used for the
treatment of severe hypertension. In studies 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 - ANSWER 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 lisinopril. 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 - ANSWER B
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 older provided additional benefit compared to a
goal SBP of <140-160 mm Hg or <140-149 mm Hg. Accordingly, the JNC 8 panel
recommends a goal SBP of <150 mm Hg and a goal diastolic blood pressure of <90
mm Hg in those age 60 or older (SOR A). The higher target blood pressure
2023 ( A+ GRADED 100% VERIFIED)
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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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) - ANSWER 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 benefit has been seen with doxazosin, there is no
contraindication to its use in patients with diabetes.
A 44-year-old male has a 1-week history of generalized headaches and nonspecific
dizziness. His past medical history is notable only for a 3-year history of
hypertension, which has been poorly controlled because of a lack of adherence to
his drug regimen. His renal status was normal 1 month ago. On examination his
blood pressure is 250/150 mm Hg, and you note cotton-wool exudates on
funduscopic examination. Laboratory evaluation reveals normal serum electrolytes, a
serum creatinine level of 3.8 mg/dL (N 0.7-1.3), and a BUN level of 60 mg/dL (N 6-
20). A urinalysis shows gross hematuria and 3+ proteinuria.Which one of the
following will rapidly lower his blood pressure and increase renal blood flow?
Diazoxide (Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam (Corlopam)
Nitroprusside (Nitropress) - ANSWER D
, Fenoldopam is a selective peripheral dopamine-receptor agonist used for the
treatment of severe hypertension. In studies 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 - ANSWER 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 lisinopril. 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 - ANSWER B
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 older provided additional benefit compared to a
goal SBP of <140-160 mm Hg or <140-149 mm Hg. Accordingly, the JNC 8 panel
recommends a goal SBP of <150 mm Hg and a goal diastolic blood pressure of <90
mm Hg in those age 60 or older (SOR A). The higher target blood pressure
