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Practice Exam Two

FS is a 56-year-old man with diabetes mellitus and newly diagnosed hypertension. His mean blood pressure in clinic today after three proper measurements is 158/101 mm Hg. He is not currently on treatment. Which of the following drug regimens would be the most appropriate to treat FS?

A. Chlorthalidone

B. Quinapril

C. Benazepril + amlodipine

D. Benazepril + losartan

E. Atenolol + HCTZ

Feedback:

Answer C is correct.

Because the patient has diabetes, ACEI therapy should be part of the combination regimen. The addition of a CCB has been shown to be beneficial in this setting.

Answer A is incorrect.

While chlorthalidone is an effective hypertensive medication, ACEI are preferred in a hypertensive patient with diabetes.

Answer B is incorrect.

ACEI therapy is warranted in this patient; however, since this patient is more than 20 mm Hg away from BP goal, combination therapy should be used.

Answer D is incorrect.

While this patient should be given an ACEI, combination therapy with an angiotensin-receptor blocker is not warranted in hypertension or to patients with diabetes (PER THE ON-TARGET TRIAL).

Answer E is incorrect.

Because the patient has a history of diabetes, the combination regimen needs to include an ACEI.

What diagnostic category is a blood pressure of 158/104 mm Hg on June 1 and a blood pressure of 150/110 mm Hg on June 4 (both of these blood pressures were taken on two separate clinic dates as the patient refused to go to the emergency department)?

A. Normal

B. Prehypertension

C. Stage 1 hypertension

D. Stage 2 hypertension

Feedback:

Answer D is correct.

Stage 2 is systolic BP greater than or equal to 160 mm Hg and diastolic BP is greater than or equal to 100 mm Hg. While the systolic BP appears to be stage 1, the diastolic BP is stage 2. Classification is driven by which one is the highest stage.

Answer A is incorrect.

Normal BP would be less than 120/80 mm Hg.

Answer B is incorrect.

Prehypertension is systolic BP 120-139 mm Hg and diastolic BP 80-89 mm Hg.

Answer C is incorrect.

Stage 1 is systolic BP ...

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