CHS Hypertension in Special Populations 3 — Questions and Answers
Question 1: Which BP target is recommended by ACC/AHA 2017 guidelines for most adults aged ≥65 years with hypertension and high cardiovascular risk?
- <150/90 mmHg
- <140/90 mmHg
- <130/80 mmHg (Correct answer)
- <120/80 mmHg
Correct answer: <130/80 mmHg
The 2017 ACC/AHA guidelines recommend a target of <130/80 mmHg for older adults with hypertension who are not institutionalized, based on SPRINT trial data.
Question 2: A woman with pre-existing hypertension becomes pregnant. Which antihypertensive is safest and most commonly used throughout pregnancy?
- Lisinopril
- Losartan
- Methyldopa (Correct answer)
- Furosemide
Correct answer: Methyldopa
Methyldopa has the longest safety record in pregnancy and is still widely used, though labetalol and nifedipine are also acceptable alternatives.
Question 3: In a child with hypertension secondary to coarctation of the aorta, BP readings will typically show which characteristic pattern?
- Higher BP in lower extremities than upper extremities
- Higher BP in upper extremities than lower extremities (Correct answer)
- Equal BP bilaterally in all limbs
- Elevated diastolic but normal systolic in all limbs
Correct answer: Higher BP in upper extremities than lower extremities
Coarctation of the aorta causes BP to be higher in the arms than legs due to obstruction of flow distal to the subclavian artery origin.
Question 4: A patient with hypertension and type 2 diabetes has a urine albumin-to-creatinine ratio of 320 mg/g. What is the recommended BP target?
- <150/90 mmHg
- <140/90 mmHg
- <130/80 mmHg (Correct answer)
- <120/80 mmHg
Correct answer: <130/80 mmHg
For patients with diabetes and hypertension, a target of <130/80 mmHg is recommended by ACC/AHA and ADA guidelines to reduce cardiovascular and renal outcomes.
Question 5: Which condition, if untreated, is associated with the highest risk of severe hypertension and hypertensive emergency during pregnancy?
- Gestational hypertension alone
- Superimposed preeclampsia on chronic hypertension (Correct answer)
- Isolated proteinuria without hypertension
- Mild essential hypertension in the first trimester
Correct answer: Superimposed preeclampsia on chronic hypertension
Superimposed preeclampsia on pre-existing chronic hypertension carries the highest risk for severe hypertension, placental abruption, and maternal-fetal complications.
Question 6: A patient with obstructive sleep apnea (OSA) and resistant hypertension fails to achieve BP control despite three medications. What intervention has the strongest evidence for reducing BP in this scenario?
- Adding a fourth antihypertensive
- Continuous positive airway pressure (CPAP) therapy (Correct answer)
- Sodium restriction alone
- Renal denervation
Correct answer: Continuous positive airway pressure (CPAP) therapy
CPAP therapy reduces nocturnal sympathetic surges and catecholamine release in OSA, leading to meaningful reductions in 24-hour BP, particularly in patients with resistant hypertension.
Question 7: In patients with hypertension and a history of ischemic stroke or TIA, which drug combination has the strongest evidence for reducing recurrent stroke risk?
- Calcium channel blocker + beta-blocker
- ACE inhibitor + thiazide diuretic (Correct answer)
- ARB + alpha-blocker
- Beta-blocker + potassium-sparing diuretic
Correct answer: ACE inhibitor + thiazide diuretic
The PROGRESS trial demonstrated that perindopril plus indapamide (an ACE inhibitor/thiazide combination) significantly reduced recurrent stroke in patients with prior cerebrovascular disease.
CHS Hypertension in Special Populations 3
Which BP target is recommended by ACC/AHA 2017 guidelines for most adults aged ≥65 years with hypertension and high cardiovascular risk?