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Chapter 3. Hypertension

According to the 2017 guidelines for hypertension, what is the BP goal for a 58-year-old African American male with diabetes and chronic kidney disease?

a. <130/80 mm Hg

b. <140/90 mm Hg

c. <150/90 mm Hg

d. <160/100 mm Hg

Answer a is correct. All patients with hypertension and cardiovascular disease or other comorbid conditions such as CKD and diabetes should have a goal blood pressure of <130/80 mm Hg.

Answers b, c, d are incorrect. For adults with confirmed hypertension and known stable CVD or ≥10% 10-year ASCVD risk, a BP target of <130/80 mm Hg is recommended. BP should be categorized as normal, elevated, or stages 1 or 2 hypertension to prevent and treat high BP. Normal BP is defined as <120/<80 mm Hg; elevated BP 120-129/<80 mm Hg; hypertension stage 1 is 130-139 or 80-89 mm Hg, and hypertension stage 2 is ≥140 or ≥90 mm Hg. Prior to labeling a person with hypertension, it is important to use an average based on ≥2 readings obtained on ≥2 occasions to estimate the individual’s level of BP.

Which of the following recommendations for lifestyle modification is correct?

a. A minimum weight loss of 15 lb

b. Sodium restriction of 4 g or less per day

c. Reduce alcohol intake to no more than two drinks a day for a woman, one for a man

d. Exercise for at least 30 minutes most days of the week

e. Adopt an eating plan low in potassium and carbohydrates

Answer d is correct. Thirty minutes per day is the minimum recommendation for physical activity in most patient populations. Regular physical activity can lower BP by 2 to 9 mm Hg. It is important to make sure that all patients have been clinically cleared to engage in physical activity by their primary care provider, cardiologist, or other responsible provider.

Answer a is incorrect. Although many patients may require a weight loss of 15 lb or more, the recommendation is to maintain normal body weight, which is a BMI of 18.5 to 24.9 kg/m2. Maintaining normal body weight can lower BP by 5 to 20 mm Hg/10 kg weight loss.

Answer b is incorrect. The recommendation is no more than 2.4 g of sodium per day. Restriction of sodium can decrease BP by 2 to 8 mm Hg.

Answer c is incorrect. Alcohol should be no more than one drink per day for a woman and two drinks per day for a man. A drink is considered to be a 12 ounces of beer, a 5 ounces glass of wine, or 1.5 ounces of 80-proof whiskey. Moderating the intake of alcohol can lower BP by 2 to 4 mm Hg.

Answer e is incorrect. The DASH plan is low in sodium and fat (saturated and total) and high in potassium, fruits, and vegetables, and low-fat dairy products. Adopting the DASH eating plan can lower BP by 8 to 14 mm Hg.

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