1. Which on of the following is associated with an increased risk of angioedema in African American patients?
A) Angiotensin II antagonists
B) Long acting dihydropyridine calcium channel blockers
C) Thiazide diuretics
D) ACE inhibitors
E) Beta blockers
Answer: D – African Americans are 2 - 4 x more likely to develop angioedema from ACE Inhibitors than other groups. (JNC 7 Report)
2. A 60 year old man with hypertension and diabetes has a baseline creatinine of 1.6 mg/dL. His blood pressure is 145/93 at this visit, and he was started on lisinopril. Two weeks later, he is found to have a blood pressure of 130/78, and a serum creatinine of 2.1 mg/dL. A repeat serum creatinine one week later is stable at 2.1 mg/dL. Which one of the following is the most appropriate course of action?
A) Discontinue the lisinopril
B) Continue the lisinopril at the same dosage
C) Increase the lisinopril
D) Discontinue the lisinopril
E) Assess and evaluate the patient for bilateral renal stenosis
Answer: B) When initiating ACE inhibitors, a rise of up to 35% above baseline in creatinine is acceptable. His baseline creatinine was 1.6 mg/dL and rose to 2.1 mg/dL which is a 31.25% rise. (JNC 7 Report)
3. Which of the following antihypertensive agents is associated with favorable outcomes in patients with congestive heart failure?
A) Thiazides, Beta blockers, ACE inhibitors, Angiotensin II antagonists, Long acting dihydropyridine calcium channel blockers
B) Thiazides, Beta blockers, ACE inhibitors, Angiotensin II antagonists, Short acting dihydropyridine calcium channel blockers
C) Thiazides, Beta blockers, ACE inhibitors, Long acting dihydropyridine calcium channel blockers
D) Thiazides, Beta blockers, ACE inhibitors, Short acting dihydropyridine calcium channel blockers
E) Thiazides, Beta blockers, ACE inhibitors, Angiotensin II antagonists, Aldosterone antagonists
Answer: E – For patients with congestive heart failure, diuretics reduce heart failure; beta blockers reduce cardiac work demand; and ACE inhibitors and ARBs reduce afterload. Low dose aldosterone antagonists reduce morbidity and mortality in CHF but these agents should not be titrated to higher levels (as other BP medications) as they may be associated with negative outcomes. (JNC 7 Report)
4. Causes of resistant hypertension can include:
A) Patient use of aspartame, excess sodium intake, inadequate
diuretic therapy, use of herbal supplements such as Ma Huang.
B) Uncontrolled diabetes, excess sodium intake, inadequate diuretic
therapy, use of pseudoephedrine.
C) Improper BP measurement, excess sodium intake, inadequate
diuretic therapy, use of oral contraceptive pills.
D) Improper BP measurement, decreased protein intake, inadequate
diuretic therapy, recent use of cocaine.
Answer – C) Causes of resistant hypertension include improper BP
measurement; excess sodium intake; inadequate diuretic therapy;
inadequate antihypertension medication doses; drug actions and
interactions (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs),
illicit drugs, sympathomimetics, oral contraceptives);
over-the-counter drugs (ex. pseudoephedrine) and herbal supplements
(ex. ephedra, Ma Huang, St. John’s wort); excess alcohol intake; and
underlying identifiable causes of hypertension (secondary
hypertension). Aspartame use, uncontrolled diabetes, and decreased
protein intake are not known to cause resistant hypertension. (JNC
7 Report)
5. Which of the following antihypertensive agents has not been shown to be of benefit in a hypertensive patient with diabetes?
A) Beta blockers
B) Calcium channel blockers
C) Alpha blockers
D) Angiotensin II antagonists
E) Thiazide diuretics
Answer – C) ACE inhibitors and ARBs are renal protective in addition to lowering blood pressure which makes these agents ideal first line choices for these conditions. Calcium channel blockers and thiazide diuretics have also been found to benefit diabetic hypertensive patients. Beta blockers in diabetics, contrary to common teachings, do not mask hypoglycemia and are actually excellent reducers of morbidity and mortality. Alpha blockers have not been found to be of benefit in diabetic hypertensive patients. (JNC 7 Report).