CHS Hypertension in Special Populations 2

Question 1

A 72-year-old patient has an SBP of 162 mmHg and DBP of 68 mmHg. What type of hypertension does this represent and what is the primary target organ concern?

Accepted Answer

Isolated systolic hypertension; increased pulse pressure and cardiovascular risk

Answer

Isolated systolic hypertension (ISH) is the most common form in elderly patients and is defined as SBP ≥140 with DBP <90, carrying significant cardiovascular morbidity risk due to arterial stiffness.

Question 2

Which antihypertensive drug class is considered most effective and guideline-recommended as first-line therapy for hypertension in patients with chronic kidney disease (CKD) with proteinuria?

Accepted Answer

ACE inhibitors or ARBs

Answer

ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, providing both antihypertensive and nephroprotective effects in CKD.

Question 3

A 14-year-old boy has a BP of 138/86 mmHg confirmed on three occasions. According to pediatric guidelines, what is the next appropriate step?

Accepted Answer

Initiate lifestyle modifications and evaluate for secondary causes

Answer

In adolescents with confirmed hypertension, secondary causes must be ruled out and lifestyle modifications (diet, exercise, weight loss) are first-line before pharmacotherapy.

Question 4

A pregnant woman at 34 weeks gestation has BP 158/104 mmHg, 2+ proteinuria, and mild headache. Which diagnosis is most consistent and which drug is contraindicated?

Accepted Answer

Preeclampsia; ACE inhibitors contraindicated

Answer

Preeclampsia presents with new-onset hypertension and proteinuria after 20 weeks; ACE inhibitors and ARBs are absolutely contraindicated in pregnancy due to fetal toxicity.

Question 5

In patients with hypertension and heart failure with reduced ejection fraction (HFrEF), which combination of drug classes has been shown to reduce mortality?

Accepted Answer

ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists

Answer

The combination of ACE inhibitors/ARBs (or ARNI), beta-blockers, and MRAs forms the foundational mortality-reducing therapy in HFrEF per ACC/AHA guidelines.

(CHS) Certified Hypertension Specialist Practice Test

(CHS) Certified Hypertension Specialist Practice Test

CHS Hypertension in Special Populations 2