Free BCACP Hypertension and Dyslipidemia Therapy Questions and Answers — Questions and Answers
Question 1: A 68-year-old African American male presents for a follow-up visit for his hypertension. His current blood pressure is 148/92 mmHg. His current medications include lisinopril 40 mg daily. He has no other compelling indications. According to the JNC 8 guidelines, which of the following is the most appropriate next step in managing his hypertension?
- Increase lisinopril to 80 mg daily.
- Add amlodipine 5 mg daily. (Correct answer)
- Add metoprolol succinate 50 mg daily.
- Add losartan 50 mg daily.
Correct answer: Add amlodipine 5 mg daily.
JNC 8 guidelines recommend initial or add-on antihypertensive treatment with a thiazide diuretic or a calcium channel blocker (CCB) for black patients. Since the patient is already on an ACE inhibitor without adequate control, adding a CCB like amlodipine is a recommended next step. Increasing the ACE inhibitor or adding an ARB would be less effective in this patient population, and a beta-blocker is not a first-line agent unless there is a specific indication like post-MI or heart failure.
Question 2: A 55-year-old female with a history of a myocardial infarction 2 years ago is on atorvastatin 80 mg daily. Her recent LDL-C is 85 mg/dL. Her other medications are maximized and she is adherent. According to the 2026 ACC/AHA Dyslipidemia Guideline, what is the most appropriate recommendation to further reduce her ASCVD risk?
- Continue current therapy as LDL-C goal is met.
- Add fenofibrate to her current regimen.
- Switch atorvastatin to rosuvastatin 40 mg daily.
- Add ezetimibe 10 mg daily. (Correct answer)
Correct answer: Add ezetimibe 10 mg daily.
For patients with clinical ASCVD at very high risk, the 2026 ACC/AHA guideline recommends an LDL-C goal of <55 mg/dL. Since the patient is on a maximally tolerated high-intensity statin and her LDL-C is above this goal, adding a non-statin agent like ezetimibe is the most appropriate next step to further lower LDL-C. Fenofibrate is not indicated for LDL lowering in this context. Switching to another high-intensity statin may provide a small additional reduction, but adding ezetimibe is a more effective and guideline-supported strategy.
Question 3: A 62-year-old patient with hypertension is currently taking hydrochlorothiazide 25 mg, lisinopril 40 mg, and amlodipine 10 mg daily. Her average home blood pressure readings are 145/95 mmHg. She has no other significant comorbidities. Which of the following represents the best therapeutic addition to manage her resistant hypertension?
- Clonidine
- Doxazosin
- Spironolactone (Correct answer)
- Hydralazine
Correct answer: Spironolactone
This patient has resistant hypertension, defined as uncontrolled blood pressure despite the use of three antihypertensive agents of different classes, including a diuretic. For resistant hypertension, a mineralocorticoid receptor antagonist (MRA) like spironolactone is the preferred fourth-line agent, as demonstrated in the PATHWAY-2 trial. Clonidine, doxazosin, and hydralazine are considered alternative add-on agents but are not the preferred next step over spironolactone.
Question 4: A 48-year-old male with no history of ASCVD has a 10-year ASCVD risk of 15% calculated using the PREVENT equations. His LDL-C is 145 mg/dL despite lifestyle modifications. According to the 2026 ACC/AHA Dyslipidemia Guideline, which of the following is the most appropriate initial therapy?
- Atorvastatin 40 mg daily (Correct answer)
- Pravastatin 20 mg daily
- Ezetimibe 10 mg daily
- Lovastatin 10 mg daily
Correct answer: Atorvastatin 40 mg daily
For primary prevention in a patient with an intermediate to high 10-year ASCVD risk (≥7.5% to <20%), guidelines recommend initiating a moderate-intensity statin. However, given the risk of 15% and an LDL-C well above the goal of <100 mg/dL, initiating a high-intensity statin like atorvastatin 40 mg to achieve at least a 50% reduction in LDL-C is a reasonable and often preferred approach. Atorvastatin 40 mg is a high-intensity statin, while pravastatin 20 mg and lovastatin 10 mg are low-intensity. Ezetimibe is not a first-line agent for primary prevention.
Question 5: Which of the following lifestyle modifications is consistently shown to have the most significant impact on lowering blood pressure?
- Reducing dietary sodium intake (Correct answer)
- Increasing dietary potassium intake
- Engaging in regular aerobic exercise
- Moderating alcohol consumption
Correct answer: Reducing dietary sodium intake
While all listed lifestyle modifications are important and recommended for managing hypertension, reducing dietary sodium intake, particularly by following the DASH diet, has been demonstrated to have the most substantial effect on lowering blood pressure, especially in salt-sensitive individuals. The effect of sodium restriction is often more pronounced than that of potassium supplementation, exercise, or alcohol moderation alone.
Question 6: A 59-year-old patient with type 2 diabetes and hypertension is being initiated on antihypertensive therapy. The patient is of non-black ethnicity. According to JNC 8 guidelines, which of the following medication classes would be an appropriate initial choice?
- Beta-blocker
- Alpha-blocker
- Loop diuretic
- Angiotensin-converting enzyme (ACE) inhibitor (Correct answer)
Correct answer: Angiotensin-converting enzyme (ACE) inhibitor
The JNC 8 guidelines recommend one of four medication classes for initial antihypertensive treatment in the general non-black population, including those with diabetes: a thiazide diuretic, a calcium channel blocker, an ACE inhibitor, or an angiotensin receptor blocker (ARB). Beta-blockers, alpha-blockers, and loop diuretics are not considered first-line agents for the initial treatment of hypertension in this patient without other compelling indications.
Free BCACP Hypertension and Dyslipidemia Therapy Questions and Answers
A 68-year-old African American male presents for a follow-up visit for his hypertension.
His current blood pressure is 148/92 mmHg.
His current medications include lisinopril 40 mg daily.
He has no other compelling indications.
According to the JNC 8 guidelines, which of the following is the most appropriate next step in managing his hypertension?