QUIZ 1: HYPERTENSION
A 44-year-old man with hypertension takes chlorthalidone 25 mg daily. His blood
pressure in the clinic today is 128/70 mm Hg and heart rate is 76 beats/minute.
His laboratory values are within normal limits. However, he has concerns of new-onset
erectile dysfunction.
Which one of the following is best to recommend for this adverse effect in this patient?
Change to doxazosin 2 mg daily
Change to isosorbide mononitrate ER 30 mg daily
Change to metoprolol succinate 100 mg daily
Change to telmisartan 40 mg daily
A 50-year-old African American man has had an average blood pressure of 136/78 mm
Hg and heart rate of 72 beats/minute over the past two visits.
He is a smoker but has no other relevant medical history. His TC is 240 mg/dL and HDL
is 32 mg/dL.
Which one of the following is best to recommend to manage this patient’s blood
pressure?
Group of answer choices
Lifestyle modifications plus hydrochlorothiazide 12.5 mg and lisinopril 20 mg daily
Lifestyle modifications plus atenolol 50 mg daily
Lifestyle modifications plus chlorthalidone 25 mg daily
This patient has stage 1 hypertension, according to the 2017 ACC/AHA hypertension guidelines.
His ASCVD 10-year risk score is 12.0%, according to the pooled cohort equations, which places
him in the category of patients that should be initiated on antihypertensive therapy.
This choice is for an appropriate first line agent and starting dose.
Lifestyle modifications only
A 53-year-old man with a history of hypertension, dyslipidemia, and type 2 diabetes is
discharged from the hospital 2 weeks after an acute MI. His home drugs include aspirin
81 mg daily, prasugrel 10 mg daily, and atorvastatin 40 mg daily.
During his hospitalization, the patient’s blood pressure was low; his blood pressure
medications were discontinued and were not resumed on discharge.
Today, his blood pressure is 146/80 mm Hg and heart rate is 52 beats/minute.
Which one of the following is best to initiate in this patient today?
,Group of answer choices
Chlorthalidone 25 mg daily
Lisinopril 10 mg daily
Because this patient has had a recent MI, the preferred antihypertensive would be a β-blocker.
However, this patient has a heart rate of 52 beats/minute, making β-blocker use unsafe.
Lisinopril is the best option for this patient, given that ACEIs or ARBs are recommended for
patients with a history of an MI, together with β-blockers.
Amlodipine 5 mg daily
Metoprolol succinate 50 mg daily
Question 51 pts
A patient calls your clinic, worried because his blood pressure was 192/98 mm Hg on his
home blood pressure monitor. He repeated it to confirm and had a similar result. He
denies feeling any symptoms and denies missing any of his regular antihypertensives.
The patient takes chlorthalidone 25 mg daily and amlodipine 5 mg daily.
In addition to arranging for prompt outpatient follow up, which one of the following is
best to recommend for this patient?
Group of answer choices
Take one extra dose of chlorthalidone 25 mg today only
Initiate clonidine 0.1 mg every hour until blood pressure is normalized
Go to the ED for evaluation of hypertensive emergency
Increase amlodipine to 10 mg daily
The best treatment for hypertensive urgency is to titrate the chronic medication, and this is a
reasonable dose increase to make; making this the best choice.
Question 4
A 59-year-old man with labile hypertension is seen in your clinic. He takes amlodipine 10
mg daily and chlorthalidone 25 mg every morning.
He reports having blood pressure elevations starting at 4 p.m. that last until 10 p.m. The
patient keeps excellent home blood pressure records; his average blood pressure during
this time is 160/90 mm Hg, and his blood pressure during the morning and early
afternoon is 118–126/62–70 mm Hg.
Which one of the following is best to recommend to manage this patient’s blood
pressure elevation during this limited time?
Group of answer choices
Start lisinopril 10 mg at 3 p.m.
Start captopril 12.5 mg at 3 p.m.
Start lisinopril 10 mg in the morning
Start captopril 12.5 mg in the morning
, Question 11 pts
A 55-year-old woman has a new diagnosis of hypertension. Her average blood pressure
on her ABPM was 158/92 mm Hg. She has implemented dietary changes, but her blood
pressure remains elevated.
You are consulted to initiate hypertension treatment. Her other medical history is
significant for allergic rhinitis and hypothyroidism.
Her laboratory values are all within normal limits.
Which one of the following is best to recommend initiating in this patient?
Group of answer choices
Metoprolol succinate 50 mg daily
Chlorthalidone 25 mg plus lisinopril 10 mg daily-
This patient has stage 2 hypertension, with an average BP high enough to justify using an initial treatment
approach with two medications. Dosing and drug selection are both appropriate for initial management.
Metoprolol succinate 50 mg plus chlorthalidone 25 mg daily
Hydrochlorothiazide 25 mg daily
Question 2
A 55-year-old woman has a new diagnosis of hypertension. Her average blood pressure
on her ABPM was 158/92 mm Hg. She has implemented dietary changes, but her blood
pressure remains elevated.
You are consulted to initiate hypertension treatment. Her other medical history is
significant for allergic rhinitis and hypothyroidism.
Her laboratory values are all within normal limits.
Which one of the following is best to recommend initiating in this patient?
Metoprolol succinate 50 mg daily
Correct!
Chlorthalidone 25 mg plus lisinopril 10 mg daily
This patient has stage 2 hypertension, with an average BP high enough to justify using an initial
treatment approach with two medications. Dosing and drug selection are both appropriate for
initial management.
Metoprolol succinate 50 mg plus chlorthalidone 25 mg daily
A 44-year-old man with hypertension takes chlorthalidone 25 mg daily. His blood
pressure in the clinic today is 128/70 mm Hg and heart rate is 76 beats/minute.
His laboratory values are within normal limits. However, he has concerns of new-onset
erectile dysfunction.
Which one of the following is best to recommend for this adverse effect in this patient?
Change to doxazosin 2 mg daily
Change to isosorbide mononitrate ER 30 mg daily
Change to metoprolol succinate 100 mg daily
Change to telmisartan 40 mg daily
A 50-year-old African American man has had an average blood pressure of 136/78 mm
Hg and heart rate of 72 beats/minute over the past two visits.
He is a smoker but has no other relevant medical history. His TC is 240 mg/dL and HDL
is 32 mg/dL.
Which one of the following is best to recommend to manage this patient’s blood
pressure?
Group of answer choices
Lifestyle modifications plus hydrochlorothiazide 12.5 mg and lisinopril 20 mg daily
Lifestyle modifications plus atenolol 50 mg daily
Lifestyle modifications plus chlorthalidone 25 mg daily
This patient has stage 1 hypertension, according to the 2017 ACC/AHA hypertension guidelines.
His ASCVD 10-year risk score is 12.0%, according to the pooled cohort equations, which places
him in the category of patients that should be initiated on antihypertensive therapy.
This choice is for an appropriate first line agent and starting dose.
Lifestyle modifications only
A 53-year-old man with a history of hypertension, dyslipidemia, and type 2 diabetes is
discharged from the hospital 2 weeks after an acute MI. His home drugs include aspirin
81 mg daily, prasugrel 10 mg daily, and atorvastatin 40 mg daily.
During his hospitalization, the patient’s blood pressure was low; his blood pressure
medications were discontinued and were not resumed on discharge.
Today, his blood pressure is 146/80 mm Hg and heart rate is 52 beats/minute.
Which one of the following is best to initiate in this patient today?
,Group of answer choices
Chlorthalidone 25 mg daily
Lisinopril 10 mg daily
Because this patient has had a recent MI, the preferred antihypertensive would be a β-blocker.
However, this patient has a heart rate of 52 beats/minute, making β-blocker use unsafe.
Lisinopril is the best option for this patient, given that ACEIs or ARBs are recommended for
patients with a history of an MI, together with β-blockers.
Amlodipine 5 mg daily
Metoprolol succinate 50 mg daily
Question 51 pts
A patient calls your clinic, worried because his blood pressure was 192/98 mm Hg on his
home blood pressure monitor. He repeated it to confirm and had a similar result. He
denies feeling any symptoms and denies missing any of his regular antihypertensives.
The patient takes chlorthalidone 25 mg daily and amlodipine 5 mg daily.
In addition to arranging for prompt outpatient follow up, which one of the following is
best to recommend for this patient?
Group of answer choices
Take one extra dose of chlorthalidone 25 mg today only
Initiate clonidine 0.1 mg every hour until blood pressure is normalized
Go to the ED for evaluation of hypertensive emergency
Increase amlodipine to 10 mg daily
The best treatment for hypertensive urgency is to titrate the chronic medication, and this is a
reasonable dose increase to make; making this the best choice.
Question 4
A 59-year-old man with labile hypertension is seen in your clinic. He takes amlodipine 10
mg daily and chlorthalidone 25 mg every morning.
He reports having blood pressure elevations starting at 4 p.m. that last until 10 p.m. The
patient keeps excellent home blood pressure records; his average blood pressure during
this time is 160/90 mm Hg, and his blood pressure during the morning and early
afternoon is 118–126/62–70 mm Hg.
Which one of the following is best to recommend to manage this patient’s blood
pressure elevation during this limited time?
Group of answer choices
Start lisinopril 10 mg at 3 p.m.
Start captopril 12.5 mg at 3 p.m.
Start lisinopril 10 mg in the morning
Start captopril 12.5 mg in the morning
, Question 11 pts
A 55-year-old woman has a new diagnosis of hypertension. Her average blood pressure
on her ABPM was 158/92 mm Hg. She has implemented dietary changes, but her blood
pressure remains elevated.
You are consulted to initiate hypertension treatment. Her other medical history is
significant for allergic rhinitis and hypothyroidism.
Her laboratory values are all within normal limits.
Which one of the following is best to recommend initiating in this patient?
Group of answer choices
Metoprolol succinate 50 mg daily
Chlorthalidone 25 mg plus lisinopril 10 mg daily-
This patient has stage 2 hypertension, with an average BP high enough to justify using an initial treatment
approach with two medications. Dosing and drug selection are both appropriate for initial management.
Metoprolol succinate 50 mg plus chlorthalidone 25 mg daily
Hydrochlorothiazide 25 mg daily
Question 2
A 55-year-old woman has a new diagnosis of hypertension. Her average blood pressure
on her ABPM was 158/92 mm Hg. She has implemented dietary changes, but her blood
pressure remains elevated.
You are consulted to initiate hypertension treatment. Her other medical history is
significant for allergic rhinitis and hypothyroidism.
Her laboratory values are all within normal limits.
Which one of the following is best to recommend initiating in this patient?
Metoprolol succinate 50 mg daily
Correct!
Chlorthalidone 25 mg plus lisinopril 10 mg daily
This patient has stage 2 hypertension, with an average BP high enough to justify using an initial
treatment approach with two medications. Dosing and drug selection are both appropriate for
initial management.
Metoprolol succinate 50 mg plus chlorthalidone 25 mg daily
