Clinical Management of 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. If a systolic blood pressure remains greater than _____ mm Hg, medication should be tried.

a) 120
b) 140
c) 160

2. Optimal blood pressure in an adult is defined as:

a) less than 120/80 mm Hg
b) 140/90 mm Hg
c) less than 110/70 mm Hg
d) 160/90 mm Hg

3. According to the Joint National Convention 6, a blood pressure between 120-130/80-89 mm Hg is:

a) normal
b) prehypertension
c) stage 1 hypertension
d) stage 2 hypertension

4. The diagnosis of hypertension should not be based on one visit, unless the blood pressure is greater than 160-165/100-105 mm Hg, then specific treatment is indicated.

a) true
b) false

5. More patients with white coat syndrome have which of the following when compared with normotensive patients:

a) family history and smoke
b) elevated cholesterol levels and obesity
c) smoke and have high levels of stress
d) obesity and diabetes

6. The phenomenon of being a “nondipper” is more common in:

a) obese patients who smoke
b) the Hispanic population
c) diabetic patients with a family history
d) patients in kidney failure
e) the black population

7. A reduction of _________ calories equal 1 lb of weight loss.

a) 2,000
b) 2,500
c) 3,000
d) 3,500
e) 4,000

8. The salt-sensitive patient is usually evident in:

a) obese patients and those who smoke
b) patients who are already hypertensive
c) black patients and the elderly
d) middle-aged patients with diabetes

9. A dietary potassium intake of about ______ to ______ mEq/day is recommended regardless whether hypertension is present.

a) 50, 80
b) 60, 100
c) 40, 120
d) 30, 60

10. Exercise is a definitive antihypertensive therapy.

a) true
b) false

11. A recent survey revealed that 20 % of people believe which of the following alone will control blood pressure:

a) reduce salt intake
b) exercise more
c) lose weight
d) stop smoking

12. Which of the following is a suggested initial approach to manage a patient with an initial blood pressure of 140/90 mm Hg:

a) add drug therapy
b) restrict sodium to 2 to 2.4 g/day
c) decrease calcium and magnesium intake
d) increase the intake of garlic

13. In two trials, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and Controlled Onset Verapamil Investigation of Cardiovascular End Points Trial (CONVINCE), control of the systolic blood pressure proved most difficult in patients:

a) in chronic kidney failure
b) who had a recent heart attack
c) who were diabetic
d) with a body mass index of 35
e) who were older

14. The hypothesis of the J-shaped curve suggests that coronary arteries fill during diastole, and a decrease in the diastolic blood pressure to <80-85 mm Hg in patients with coronary artery disease may decrease coronary flow, and ischemic heart disease events may actually be increased at these blood pressure levels.

a) true
b) false

15. The experts’ response to the 1999 World Health Organization International Society of Hypertension guidelines was:

a) further studies need to be conducted
b) there was considerable evidence to support them
c) they were applicable to only a small percentage of the population

16. This diuretic blocks the reabsorption of sodium in the early distal tubule:

a) thiazide diuretic
b) loop diuretic
c) K-sparing diuretic
d) aldosterone antagonists

17. The ultimate result of diuretic therapy is:

a) a decrease in cardiac output
b) an increase in renin/angiotensin activity
c) a reduction of arterial resistance and blood pressure
d) a decrease in plasma volume and renal perfusion

18. Hypokalemia should be avoided if possible, especially in:
  1. elderly patients
  2. patients in renal failure
  3. patients on digitalis
  4. patients with cardiac arrhythmias
  5. patients with diabetes in whom the degree of hypokalemia may affect insulin utilization

a) 1, 2, and 4
b) 2 and 5
c) 3 and 4
d) 2, 4, and 5
e) 1, 3, and 5

19. Loop diuretics are usually reserved for patients with creatinine levels of greater than 2 mg % and for patients with:

a) congestive heart failure
b) end-stage renal disease
c) COPD
d) diabetes

20. With the use of ACE inhibitors, blood pressure decreases because of:

a) decreased cardiac output and decreased plasma volume
b) vasodilation and reduction in peripheral resistance
c) increased renal perfusion and a decrease in arterial resistance
d) increased arterial resistance and a decrease in renin/angiotension activity

21. In the Heart Outcomes Prevention Evaluation Trial (HOPE), it showed the addition of an ACE inhibitor to other medications:

a) lowers nocturnal blood pressure
b) decreases the risk of cardiovascular disease
c) reduces morbidity and mortality in patients at a high risk for cardiovascular events
d) resulted in renal failure with patients predisposed to renal artery stenosis

22. In the Swedish Trial in Old Patients With Hypertension 2, it was found that:

a) those who took an ACE inhibitor and diuretic had a lower mortality rate
b) in diabetic patients, an occurrence of a heart attack was decreased with a calcium antagonist
c) CHF was reduced with a calcium channel blocker
d) there was no difference in morbidity and mortality outcome between the “older” and “newer” drugs

23. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial of the remaining 33,000 patients, ____% had attained a goal diastolic blood pressure of less than 90 mm Hg and _____% had achieved a systolic blood pressure of less than 140 mm Hg.

a) >90, 80
b) >90, 67
c) >98, 95
d) <90, 83

24. Side effects of the ACE inhibitors are uncommon except for:

a) a rash
b) loss of appetite
c) cough
d) angioedema

25. ACE inhibitors are effective in patients with high-renin hypertension and also in:

a) young and middle-aged whites
b) blacks
c) elderly

26. The use of angiotensin receptor blockers:

a) decreases the movement of calcium ions across cardiac membranes
b) inhibits reabsorption of sodium and chloride
c) may cause bone marrow depression
d) reduces vascular resistance without reducing cardiac output

27. Angiotensin receptor blockers increase the production and availability of nitric oxide which is:

a) produced by the kidneys
b) a strong vasodilator substance
c) a blocking agent
d) activated at the blood vessel walls

28. In LIFE, VALUE, and SCOPE studies, new onset diabetes was _____ with an angiotensin receptor blocker-based regimen than with other therapy.

a) higher
b) lower

29. With the inhibition of renin activity with a drug such as Tekturna, there is ultimately a decreased production of:

a) plasma
b) aldosterone
c) angiotensin 11

30. Calcium channel blockers lower blood pressure by inhibiting the entry of calcium ions into:

a) vascular smooth muscle cells
b) the loop of Henle
c) the bloodstream

31. The ________ calcium channel blockers act primarily on peripheral vascular beds and have little effect on cardiac muscle contraction or AV conduction.

a) nondihydropyridine
b) dihydropyridine

32. In the Hypertension Optimal Treatment Trial, individuals who achieved the lower blood pressure felt better, leading to the fact that hypertension is not always “silent.” One symptom patients may have is:

a) blood shot eyes
b) nervousness
c) difficulty seeing
d) a vague headache

33. The ______-acting preparations of calcium channel blockers should be used with caution or not at all in the treatment of hypertension.

a) longer
b) shorter

34. In the Anglo Scandinavian Cardiac Outcomes Trial, the ASCOT investigators’ conclusion that “contemporary” medications were superior to “old” medications, which in their summary includes diuretics, may not truly reflect the data.

a) true
b) false

35. B-blockers should not be used or used with care in which of the following:
  1. patients with asthma
  2. patients with severe peripheral artery disease
  3. patients with Raynaud’s phenomenon
  4. patients who have had a recent heart attack
  5. patients with insulin-dependent diabetes
  6. patients in chronic renal failure

a) 1, 4, and 6
b) 4 and 6
c) 1, 2, 3, and 5
d) 2, 4, and 5
e) 3, 4, 5, and 6

36. One way B-blockers lower blood pressure is by:

a) inducing bradycardia
b) causing dieresis
c) increasing the release of renin
d) decreasing cardiac output

37. Agents that are lipid soluble have a shorter duration of action since they are inactivated more rapidly by the liver.

a) true
b) false

38. Beta-blockers are especially effective in:
  1. elderly hypertensive patients
  2. young, white, hypertensive patients
  3. patients with resting tachycardia
  4. black hypertensive patients
  5. patients with type 2 diabetes
  6. acute renal failure

a) 1, 4, and 5
b) 2, 5, and 6
c) 3 and 4
d) 2 and 3
e) 4 and 6

39. This is probably the most annoying side effect of B-blockers:

a) fatigue
b) vivid dreams and depression
c) sexual dysfunction
d) dyspnea

40. Two of the more common side effects of B-blockers with vasodilating properties are:

a) fatigue and shortness of breath
b) postural hypotension and dizziness
c) ankle edema and bradycardia
d) depression and headache

41. a1-blockers block or inhibit the post-synaptic a1-receptors on vascular ________ muscle.

a) cardiac
b) striated
c) smooth

42. Reserpine decreases the transport of norepinephrine into storage granules by acting on the:

a) adrenal gland
b) pituitary gland
c) kidney
d) central nervous system

43. The central antagonists have an unusual mechanism of action in the:

a) peripheral nervous system
b) vasomotor centers of the brain
c) smooth muscle

44. Side effects occur in a high percentage of patients and dropout rates from therapy can be as high as _____ %.

a) 20
b) 30
c) 40
d) 50

45. In the case of using Loniten, this drug should only be used in rare cases of severe hypertension in women because of:

a) excessive hair growth
b) deepening of the voice
c) menopause-like symptoms

46. In the initial choice of drug, cost should be considered.

a) true
b) false

47. If a patient has a concomitant disease, such as asthma, insulin-dependent diabetes or definite peripheral arterial disease, which of the following should not be used:

a) a diuretic
b) a calcium channel blocker
c) a B-blocker
d) an ace inhibitor

48. If blood pressure has been normalized for about 1 year after initial multiple drug therapy, it is reasonable to consider reducing the dosage of the ______ drug.

a) first
b) second

49. One reason for nonresponsiveness to therapy is chronic use of allergy medications which contains a vasoconstrictor.

a) true
b) false

50. Hypertension has been identified as a major cause of which of the following:

a) chronic renal failure
b) stroke
c) heart attack
d) congestive heart failure