Post-Quiz: Chronic Hypertension Pharmacotherapy

A 56-year-old male patient with a history of hypertension presents to your clinic for a follow-up appointment. His blood pressure remains uncontrolled at 155/95 mm Hg despite being on maximum doses of a single antihypertensive medication. You decide to initiate combination therapy to better control his blood pressure. Based on the American Society of Hypertension’s recommendations, which of the following combinations is considered a preferred choice for this patient?

A 55-year-old male presents to the clinic with a blood pressure of 160/100 mmHg. He has a history of hypertension for the past 10 years and has been taking lisinopril 20 mg daily for the past 5 years. He denies any symptoms, is allergic to chlorthalidone, and his physical exam is unremarkable. His laboratory values are within normal limits. What is the most appropriate next step in the management of this patient’s hypertension?

A 60-year-old female presents to her primary care physician with a history of hypertension. She reports that she has been taking lisinopril 10mg daily for the past year, but her blood pressure has not been well controlled. Her current blood pressure is 150/90 mm Hg. She has a past medical history of hyperlipidemia and is currently taking atorvastatin 20mg daily. She denies any history of cardiovascular disease or diabetes. Her family history is significant for hypertension in both parents. What is the appropriate initial treatment for this patient’s uncontrolled hypertension?

A 56-year-old male with a history of hypertension and type 2 diabetes presents for a routine checkup. His medications include lisinopril, metformin, and hydrochlorothiazide 25 mg daily. The patient complains of muscle cramps and fatigue. Laboratory results show a serum potassium level of 3.1 mEq/L (normal range: 3.5-5.0 mEq/L). Which of the following modifications to his antihypertensive regimen is most appropriate to address the patient’s hypokalemia?

A 55-year-old male patient with a history of hypertension, type 2 diabetes, and high cardiovascular risk presents to your clinic. His current blood pressure is 145/85 mm Hg. Based on the 2017 ACC/AHA guideline and other evidence, what should be the target blood pressure goal for this patient?

A 45-year-old male patient presents to your clinic with a recent diagnosis of hypertension. His blood pressure is 150/95 mmHg, and he is currently not on any antihypertensive medications. The patient is overweight with a BMI of 29, has a sedentary lifestyle, and consumes a high-sodium diet. As his primary care provider, which of the following nonpharmacological interventions would be most appropriate to recommend for this patient to help manage his hypertension?

Patient Profile:

Demographics: 52-year-old male

History of Present Illness: Patient complains of paroxysmal headaches, sweating, tachycardia, and palpitations. He also reports episodes of orthostatic hypotension and muscle cramps.

Past Medical History: Hypertension

Family History: Father had hypertension and died of a stroke at age 65; mother has type 2 diabetes.

Other Pertinent Details: The patient had a recent laboratory evaluation that showed hypokalemia, proteinuria, and red blood cells in the urine.

Based on the patient’s profile and symptoms, which of the following secondary causes of hypertension is most likely responsible for his condition?

A 78-year-old female patient with a history of hypertension, diabetes, and chronic kidney disease (CKD) presents to your clinic for a follow-up visit. Her blood pressure is consistently above 140/90 mm Hg, and she has moderately increased albuminuria. You decide to initiate pharmacologic therapy to manage her hypertension and reduce the risk of further kidney deterioration and cardiovascular events. Which of the following antihypertensive medications would be the most appropriate choice for this patient?

A 60-year-old male with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to your clinic for a follow-up appointment. His current medication regimen includes an ACE inhibitor and a thiazide diuretic. He reports experiencing a persistent dry cough since starting the ACE inhibitor. Based on his medical history and current symptoms, which of the following medication changes would be most appropriate?

A 45-year-old male presents to the clinic with a blood pressure reading of 150/90 mmHg. He has no significant past medical history and is not taking any medications. He denies any symptoms such as headache, chest pain, shortness of breath, or visual changes. Physical examination is unremarkable except for elevated blood pressure.