Hypertension

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Which of the following fats have the most calories?

a) polyunsaturated
b) monounsaturated
c) saturated
d) they all have the same

2. It's better to quit smoking even if it leads to a slight weight gain.

a) True
b) False

3. An overweight person should pay more attention to losing weight than controlling sodium in the diet.

a) True
b) False

4. Select the correct answer below:

a) Obesity in childhood increases the likelihood of adult obesity.
b) Most overweight children do not become obese.
c) both of the above
d) none of the above

5. Reducing sodium in the diet invariably leads to lower blood pressure.

a) True
b) False

6. Generally, in order to lose weight, it's better to eat three meals a day than 5 or 6 small meals.

a) True
b) False

7. In most cases, the cause of high blood pressure can be traced to one single factor.

a) True
b) False

8. High blood pressure has no symptoms.

a) True
b) False

9. What is the recommended daily intake of sodium (in milligrams)?

a) 6
b) 140
c) 2400
d) 5000

10. If your mother or father has high blood pressure, you'll get it.

a) True
b) False

11. At least 30 minutes of physical activity can help improve your heart health, but these 30 minutes of exercise should be done in one stretch.

a) True
b) False

12. All exercises give the same benefits.

a) True
b) False

13. Angina pain resulting in poor function of tiny blood vessels moving the heart is known as

a) stable angina
b) unstable angina
c) variant angina
d) microvascular angina

14. The most common trigger for angina is

a) physical exertion
b) emotional stress
c) extreme cold
d) heavy meals
e) cigarette smoking

15. Every angina attack results in some damage to the heart muscle.

a) True
b) False

16. If your HDL level is _______, your risk of hart disease goes up.

a) more than 200
b) less than 130
c) less than 35
d) more than 35

17. While buying margarine, it's better to buy soft or liquid margarine.

a) True
b) False

18. Your diet should provide you less than ____ percent of total calories as saturated fat.

a) 5
b) 10
c) 20
d) 30

19. Which among the following groups is most likely to develop high blood pressure?

a) men in the early to middle years
b) women before menopause
c) persons over age 65
d) African-American women who live in the Southeast

20. Which of the following types of hypertension can be cured?

a) primary
b) secondary
c) none

21. Select the incorrect statement below:

a) Varying the amount and type of fats, carbohydrates, and protein in the diet has little, if any, effect on blood pressure.
b) Avoiding caffeine in drinks like coffee, tea and sodas do not help prevent developing high blood pressure.
c) Garlic and onions have no effect on blood pressure.
d) Stress management helps to prevent high blood pressure.

22. For overall health women should limit their alcohol to no more than ____ drinks a day.

a) 1
b) 2
c) 3

23. Three of every four women with high blood pressure do not know they have it.

a) True
b) False

24. What's the percent of women with diabetes who have high blood pressure?

a) 5%
b) 25%
c) 65%
d) 95%

25. Most of the salt and sodium Americans consume comes from

a) salt used at the table
b) salt added during cooking
c) processed foods

26. Hypertension is defined as systolic and diastolic pressures of

a) <120 and <80
b) <130 and <85
c) 130-139 or 85-89
d) >139 or >89

27. A person's blood pressure shows systolic and diastolic readings of 145/88. Does he have hypertension?

a) yes
b) no

28. Some people have heart attacks without ever having any of the usual symptoms.

a) True
b) False

29. There are many tests used to establish CHD. However, the only certain way to diagnose and assess the extent of CHD is

a) electrocardiogram
b) stress test
c) nuclear scanning
d) coronary angiography

30. Primary prevention of hypertension can be accomplished by two strategies: population strategy and targeted strategy. Getting obese people to reduce caloric intake is an example of

a) population strategy
b) targeted strategy

31. Select the incorrect statement from the following:

a) Many hypertensives are unaware of their condition.
b) Many sustain vascular damage to their heart, brain, or kidneys.
c) Hypertensive drugs can have adverse side effects.
d) Treatment of hypertension is expensive over the long run.

32. According to the National High Blood Pressure Education Program, between 1988-91 to 1991-94, there was an __________ in the rate of awareness, treatment and control of high blood pressure in adults in the United States.

a) increase
b) decrease

33. Self-measurement of blood pressure outside the clinician's office has many advantages. Which of the following is not such an advantage?

a) distinguishing sustained hypertension from "white-coat hypertension"
b) greater accuracy
c) assessing response to hypertensive medication
d) improve adherence to treatment
e) reduce costs

34. The blood pressure of persons with hypertension tends to be higher when measured in the clinic than outside of the office.

a) True
b) False

35. Which nutrient does not belong in the following group with respect to its beneficial effect on hypertension?

a) sodium
b) potassium
c) calcium
d) magnesium

36. The J-curve hypothesis refers to

a) resistant hypertension
b) step-down therapy
c) lowering DBP too much which may increase the risk for coronary events
d) combination drug therapy

37. The initial goal of therapy in hypertensive emergencies is to reduce mean arterial blood pressure (within minutes to 2 hours)

a) to 160/100 mm Hg
b) by no more than 25 percent
c) to 120/90 mm Hg
d) by at least 35 percent

38. Women taking oral contraceptives experience a slight ________ in both SBP and DPB, usually within the normal range.

a) increase
b) decrease

39. Blood pressure goal for patients with renal insufficiency with proteinuria greater than 1 gram per 24 hours is

a) 140/90 mm Hg
b) 135/85 mm Hg
c) 125/75 mm Hg

40. Ongoing cocaine abuse causes chronic hypertension.

a) True
b) False

41. In older persons the better predictor of cardiovascular risk is

a) SBP
b) DPB
c) SBP minus DBP

42. Accurate measurement of blood pressure in older persons is especially difficult for all of the following reasons except

a) excessive vascular stiffness
b) "white-coat" hypertension
c) orthostatic fall in blood pressure and hypotension
d) presence of other drugs

43. Normal blood pressure values taken by ambulatory measurement are generally lower than clinic readings while patients are awake or asleep.

a) True
b) False

44. All of the following have been known to directly elevate blood pressure except

a) excessive alcohol intake
b) sodium
c) caffeine
d) low dietary calcium
e) low dietary potassium

45. The cardiovascular benefits of discontinuing tobacco use can be seen in as little as a year in all age groups.

a) True
b) False

46. Women taking oral contraceptives experience hypertension two to three times more commonly than those not taking oral contraceptives.

a) True
b) False

47. Initial drug therapy for hypertension should generally begin with the following drug:

a) diuretic
b) beta-blocker
c) direct vasodilators
d) calcium antagonists
e) a or b

48. The presence of hypertension is a contraindication to postmenopausal estrogen replacement therapy.

a) True
b) False

49. Which of the following nonpharmacologic therapy strategies for the treatment of hypertension in children and adolescents is most effective?

a) weight loss
b) physical activity
c) dietary intervention
d) sodium reduction

50. Elevated BP in childhood often correlates with hypertension in early adulthood.

a) True
b) False

51. The phase of the Korotkoff sounds that defines diastolic pressure in children and adolescents is

a) K4
b) K5

52. In general population only about _____ percent of children and adolescents are found to have hypertension.

a) 1
b) 3
c) 5
d) 10

53. Hypertension in children and adolescents usually is not a contraindication to participation in sports and strenuous activity.

a) True
b) False

54. Select the incorrect statement from the following:

a) Hypertension is approximately twice as common in persons with diabetes as in those without.
b) Hypertension occurs more frequently in persons with Type II diabetes than in those with Type I diabetes.
c) The prevalence of coexistent hypertension and diabetes is almost twice as great among African Americans as among whites.
d) The prevalence of hypertension and Type II diabetes increases with age.

55. The presence of diabetes may increase the risk of CVD more in women than in men.

a) True
b) False

56. In persons with diabetes mellitus there is a significant ________ in standing blood pressure observed.

a) rise
b) fall

57. Children with Type I diabetes and severe hypertension should be treated with antihypertensive drugs. In general, beta-blockers are the recommended drugs.

a) True
b) False

58. Of the antihypertensive drugs used in the treatment of diabetic persons with hypertension, one class of drugs is least useful:

a) ACE inhibitors
b) alpha-receptor blocking agents
c) thiazide diuretics
d) beta-blockers

59. Poor adherence to therapy is a major reason for inadequate control of high blood pressure and blood glucose levels. Which of the following factors is least responsible for poor adherence?

a) cost of medication
b) unclear instructions
c) managed care
d) lack of involvement of the patient in the treatment plan
e) side effects of medication

60. Which of the following hypertensive disorders in pregnancy is fairly benign?

a) chronic hypertension
b) preeclampsia
c) preeclampsia superimposed upon chronic hypertension
d) transient hypertension

61. Blood pressure usually increases early in pregnancy, reaching its peak at about the stage of pregnancy at which women usually seek obstretical care.

a) True
b) False

62. One of the following statements is incorrect:

a) Women having normotensive pregnancies have a low likelihood of developing later chronic hypertension.
b) Women with transient hypertension have high probability of ultimate essential hypertension.
c) Women with transient hypertension in one pregnancy have no significant likelihood of having transient hypertension in the next pregnancy.
d) Preeclamptic and eclamptic hypertension predict nothing.

63. Which of the following is the most sensible strategy for the management of hypertension during pregnancy?

a) weight reduction
b) exercise
c) sodium restriction
d) avoidance of alcohol and tobacco
e) all of the above

64. Therapy for preeclampsia when gestation is advanced is

a) termination of pregnancy
b) delivery

65. High blood pressure complicates almost _____ percent of all pregnancies.

a) 1
b) 5
c) 10
d) 50

66. Which of the following is the most recommended renoprotective antihyperten- sive drug?

a) ACE inhibitors
b) beta-blockers
c) diuretics
d) vasodilators

67. Usual blood pressure control (below 140/90 mm Hg) is not always effective in preventing the development of renal insufficiency in patients with essential hypertension.

a) True
b) False

68. The normal mean pulmonary artery pressure at rest is approximately

a) 14 mmHg
b) 25 mmHg
c) 30 mmHg
d) 80 mmHg

69. All of the following have been thought to trigger narrowing of the pulmonary artery except

a) diet suppressants
b) excessive salt intake
c) cocaine
d) HIV
e) pregnancy

70. Select the incorrect statement from the following:

a) In about 6 to 10 percent of cases PPH is inherited from other family members.
b) PPH affects men and women in all age ranges.
c) PPH also affects people of all racial and ethnic origins equally.
d) PPH occurs in young women between the ages of 21 and 40 almost exclusively.

71. In the PPH patient, ______ side of the heart is enlarged.

a) left
b) right
c) both
d) no

72. A variety of tests are needed to diagnose PPH. Which of the following tests allows the doctor to get a precise measure of the blood pressure in the right side of the heart and the pulmonary artery?

a) electrocardiogram
b) echocardiogram
c) pulmonary function tests
d) perfusion lung scan
e) right-heart cardiac catheterization

73. Researchers have used ambulatory blood pressure monitoring to study all of the following except

a) normal blood pressure patterns
b) prevention of high blood pressure
c) target organ complications of hypertension
d) the prognosis of cardiovascular events and mortality
e) the effects of antihypertensive drugs

74. Which method is used to determine blood pressure by ABPM devices?

a) auscultatory
b) oscillometric
c) both
d) none of the above

75. For proper management of hypertension, every patient should undergo ambulatory blood pressure monitoring at least once every 18 months.

a) True
b) False

76. APBM is not appropriate in the diagnosis of

a) hypertension in large population groups
b) "white-coat" hypertension
c) borderline hypertension with target organ damage
d) resistant hypertension

77. What is the most current and widely used technique for ambulatory blood pressure monitoring?

a) direct, intraarterial measurement
b) indirect measurement using semiautomatic Remler device
c) automatic measurement using auscultation of Korotkoff sounds or oscillometry
d) finger cuff measurement

78. The major drawback of ABPM is

a) invasive
b) bulky and noisy
c) safety and complications issues
d) cost-prohibitive for use in population at large

79. For proper interpretation of data gathered by ABPM, the patient should keep a detailed diary with information about physical and mental activity, meals, sleep, medication and other life events.

a) True
b) False

80. Cost of ABPM is about

a) $100 to $300
b) $2,000
c) $5,000
d) $12,000 to $15,000

81. The chapter lists 5 behavioral changes to improve adherence to antihypertension therapy. Select the one that's not listed:

a) taking medication
b) maintaining desirable weight
c) joining hypertensive anonymous group
d) increasing exercise
e) moderating alcohol consumption

82. If adherence problems persist, there are several possible solutions. Select the incorrect one from below:

a) involve a family member
b) schedule more frequent appointments
c) lower goals for blood pressure reduction, even temporarily
d) admit the patient to a hospital
e) refer the patient to another health professional

83. DASH diet compared three eating plans. Which had the greatest effect in reducing blood pressure?

a) diet used by most Americans
b) diet used by most Americans but higher in fruits and vegetables
c) "combination" plan

84. The benefit of lower blood pressure using DASH plan takes about 6 months to show up after starting the plan.

a) True
b) False

85. The DASH plan provides ________ milligrams of sodium per day.

a) 700
b) 1240
c) 2400
d) 3000

86. The DASH plan is rich in all of the following except

a) magnesium
b) potassium
c) calcium
d) protein and fiber
e) fat