A 61-year-old black gentleman is seen in your office. He denies any cardiac symptoms. He does not have a history of diabetes. His vitals show a heart rate of 75 bpm and blood pressure (BP) of 160/92 mmHg; examination otherwise is normal. You recommend lifestyle modification, including regular exercise and low-sodium diet. What is the initial drug of choice in managing his hypertension?

1. Metoprolol
   
2. Furosemide
   
3. Amlodipine
   
4. Lisinopril

A 25-year-old female patient comes to your office. She has a history of chronic kidney disease (CKD) stage 2. She denies any cardiac symptoms. Her vitals are heart rate 76 bpm, BP 170/98 mmHg, respiratory rate 14/min. Her physical exam is otherwise normal. She is on furosemide 40 mg daily. What would your add-on drug of choice in this patient be?

1. Amlodipine
   
2. Clonidine
   
3. Lisinopril
   
4. Hydralazine

A 49-year-old male comes to your office for an evaluation as part of his executive check-up. He reports feeling well. He denies previous history of diabetes or coronary artery disease. Physical examination is unremarkable except for his BP, which was measured at 165/98 mmHg. His BP rechecked after 5 min was 160/98 mmHg. What would your recommendation be to this patient?

1. Reassurance
   
2. Initiate drug therapy
   
3. Come back for a follow up in 3 months
   
4. Come back for a follow up after 6 months

A 50-year-old female is being evaluated in your office. She reports a history of diabetes mellitus and is taking metformin 500 mg BID. She reports no other history. She denies any cardiac symptoms. She exercises regularly. Her examination is unremarkable except for her high BP, which was measured on two occasions 5 min apart and was 170/92 mmHg. What is the initial drug of choice?

1. Prazosin
   
2. Clonidine
   
3. Atenolol
   
4. Lisinopril

A 40-year-old female is admitted to the hospital. On examination she is found to have pulmonary edema. Her past history is only significant for hypertension. She is on a medical regimen consisting of a thiazide diuretic, amlodipine, losartan, and carvedilol. Her family also gave a history of recent uncontrolled high BP and one other episode of pulmonary edema 2 months ago. Her BP was 220/110 mmHg. The rest of her examination is unremarkable. What is the initial diagnosis?

1. Pseudohypertension
   
2. Primary hyperaldosteronism
   
3. Reno-vascular hypertension
   
4. Coarctation of aorta

What is the diagnostic test of choice in the patient in Question 13.5?

1. Captopril renogram
   
2. Intravenous pyelogram
   
3. Doppler ultrasound of the renal arteries
   
4. Magnetic resonance angiography (MRA)
   
5. Captopril-stimulated plasma renin activity (PRA)

A 60-year-old female is referred to you for uncontrolled hypertension. Her primary care physician was treating her for the last 5 months. She denies any other history in the past. She drinks alcohol socially and is in the habit of chewing tobacco. On examination she weighs 75 kg, BP is 200/100 mmHg. The rest of her examination is unremarkable except for trace pedal edema. Her lab values are as follows:

• serum sodium 144 mEq/L
  
• serum potassium 3 mEq/dL
  
• serum chloride 100 mEq/L
  
• serum bicarbonate 29 mEq/L
  
• serum creatinine 0.9 mg/dL
  
• blood urea nitrogen 20 mg/dL
  
• PRA is 1.2 μg/(L h), plasma aldosterone (PA) level is 9.2 ng/L, and aldosterone excretion rate is 8 mg/day (normal is 5–10 mg/day)
  
• urine test after salt loading yields creatinine 1 g, sodium 251 mEq, and potassium 130 mEq.

Which diagnostic test would you order next?

1. Computed tomography of adrenal glands
   
2. MRA of the renal arteries
   
3. Serum cortisol and urinary free-cortisol measurement
   
4. Cosyntropin test

A 45-year-old male is referred to you for treatment of uncontrolled hypertension. He is on four different antihypertensives at maximal doses, including a thiazide-type diuretic. He denies any other medical history. He is active. His BP is 184/100 mmHg, sitting upright in a relaxed posture. His blood chemistry is unremarkable except for serum potassium of 2.9 mg/dL and a plasma renin level of <1 ng/(mL h). What is the cause of hypertension in this patient?

1. Reno-vascular hypertension
   
2. Primary aldosteronism
   
3. Pheochromocytoma
   
4. Renal parenchymal disease

What is the best screening test in evaluating the patient in question 13.8?

1. MRA of the renal arteries.
   
2. Ratio of PA to PRA
   
3. Urine metanephrine
   
4. Intravenous pyelogram

You have been referred a 52-year-old male with refractory hypertension by a primary care physician. The patient gives a history of episodes of headache, sweating,and palpitations. On examination his BP is 198/112 mmHg. Examination is otherwise unremarkable. What is the best screening test in evaluating this patient?

1. Serum cortisol
   
2. PA to PRA
   
3. Plasma catecholamines and urinary metanephrines
   
4. MRA of the abdomen

What is the BP goal for a 62-year-old patient according to the JNC 8 guidelines?

1. <140/90 mmHg
   
2. <150/90 mmHg
   
3. <160/100 mmHg
   
4. <160/90 mmHg

What is the BP goal for a 92-year old patient according to the JNC 8 guidelines?

1. <140/90 mmHg
   
2. <150/90 mmHg
   
3. <160/100 mmHg
   
4. <160/90 mmHg

What is the BP goal for a 62-year-old patient with diabetes mellitus according to the JNC 8 guidelines?

1. <140/90  mmHg
   
2. <150/90  mmHg
   
3. <160/100  mmHg
   
4. <160/90  mmHg

What is the BP goal for a 42 year old patient with diabetes mellitus according to the JNC 8 guidelines?

1. <140/90 mmHg
   
2. <150/90 mmHg
   
3. <160/100 mmHg
   
4. <160/90 mmHg

What is the BP goal for a 62-year-old patient with renal disease according to the JNC 8 guidelines?

1. <140/90 mmHg
   
2. <150/90 mmHg
   
3. <160/100 mmHg
   
4. <160/90 mmHg

What is the BP goal for a 42-year-old patient with diabetes mellitus according to the JNC 8 guidelines?

1. <140/90 mmHg
   
2. <150/90 mmHg
   
3. <160/100 mmHg
   
4. <160/90 mmHg

What is the drug of choice to treat hypertension in a black person with renal disease?

1. Diuretic
   
2. CCB
   
3. ACEI or ARB
   
4. Beta blocker

What is the drug of choice to treat hypertension in a black person with diabetes mellitus?

1. Diuretic or CCB
   
2. ACEI
   
3. ARB
   
4. Any of the above

What is the drug of choice to treat hypertension in a nonblack person with diabetes mellitus?

1. Diuretic
   
2. CCB
   
3. ACEI or ARB
   
4. Any of the above

Which is the most preferred drug to treat hypertension in pregnancy according to the JNC 8 guidelines?

1. Labetalol
   
2. Nifedipine
   
3. Methyldopa
   
4. ACEI

Which is the most preferred drug to reduce the risk of recurrent stroke according to the JNC 8 guidelines?

1. Diuretic
   
2. CCB
   
3. Clonidine
   
4. Beta blocker

Which antihypertensive agent may reduce uric acid levels?

1. Diuretic
   
2. CCB
   
3. Losartan
   
4. Candesartan

Which antihypertensive agent may reduce migraine attacks?

1. Diuretic
   
2. CCB
   
3. Losartan
   
4. Candesartan

Which antihypertensive agent may result in gynecomastia?

1. Spironolactone
   
2. CCB
   
3. Losartan
   
4. Candesartan