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Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

These are strong, independent risk factors for hypertension.

A

Obesity
weight gain

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2
Q

Low dietary intakes of ___ and ____ also may contribute to the risk of hypertension.

A

calcium
potassium

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3
Q

The two determinants of arterial pressure

A

Cardiac output
Peripheral resistance

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4
Q

Cardiac output is determined by ____ and ______

A

stroke volume
heart rate

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5
Q

The most common etiology of secondary hypertension

A

Primary renal disease

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6
Q

_____ is predominantly an extracellular ion and is a primary determinant of the extracellular fluid volume.

A

Sodium

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7
Q

Which of the following mechanisms is primarily responsible for kidney-related hypertension?
A) Excessive sodium excretion
B) Overactivity of parasympathetic nervous system
C) Diminished capacity to excrete sodium
D) Increased calcium absorption in the renal tubules

A

C

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8
Q

In the early stages of vascular volume expansion, how does blood pressure initially increase?
A) Increased peripheral resistance
B) Decreased peripheral resistance
C) Increased cardiac output
D) Decreased cardiac output

A

C

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9
Q

Which of the following is true regarding the relationship between sodium intake and blood pressure?
A) All salts of sodium significantly increase blood pressure
B) Sodium chloride (NaCl) intake is more strongly associated with increases in blood pressure
C) Sodium intake has no effect on blood pressure
D) Non-chloride salts of sodium have the strongest effect on blood pressure

A

B

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10
Q

What is the effect of increased arterial pressure on sodium excretion?
A) Decreases urinary sodium excretion
B) Increases urinary sodium excretion
C) Has no effect on sodium excretion
D) Decreases glomerular filtration rate

A

B

When arterial pressure rises in response to increased sodium intake, urinary sodium excretion increases to restore sodium balance. This process is known as “pressure-natriuresis.”

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11
Q

Which factor is least likely to contribute to hypertension in patients with end-stage renal disease (ESRD)?
A) Increased vascular volume
B) Overactivity of the renin-angiotensin system
C) Increased sodium reabsorption
D) Decreased sympathetic nervous system activity

A

D

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12
Q

Which of the following best describes the “pressure-natriuresis” phenomenon?
A) The body’s capacity to excrete sodium decreases as arterial pressure increases
B) Sodium balance is maintained through decreased glomerular filtration rate
C) As arterial pressure increases, urinary sodium excretion increases
D) Sodium excretion decreases in response to high NaCl intake

A

C

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13
Q

What is the most likely consequence in individuals with an impaired ability to excrete sodium?
A) Lower arterial pressure is needed to maintain sodium balance
B) Blood pressure remains unaffected by sodium intake
C) Greater increases in arterial pressure are required to achieve sodium balance
D) Sodium balance is maintained without an increase in arterial pressure

A

C

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14
Q

In patients with end-stage renal disease (ESRD), how is blood pressure most commonly controlled?
A) Increased potassium intake
B) Salt restriction
C) Pharmacologic blockade of the renin-angiotensin system
D) Adequate dialysis

A

D

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15
Q

Which of the following is NOT a mechanism through which the kidney affects blood pressure?
A) Excessive renin secretion
B) Overactivity of the parasympathetic nervous system
C) Sympathetic nervous system overactivity
D) Impaired sodium excretion

A

B

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16
Q

Which of the following catecholamines has a greater affinity for α-adrenergic receptors?
A) Epinephrine
B) Norepinephrine
C) Dopamine
D) Serotonin

A

B

α receptors: Norepinephrine > Epinephrine
β receptors: Epinephrine > Norepinephrine

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17
Q

What is the primary function of α1 receptors?
A) Vasodilation of smooth muscle
B) Inhibition of norepinephrine release
C) Vasoconstriction of smooth muscle
D) Relaxation of vascular smooth muscle

A

C

> α1 Receptors:
Location: Postsynaptic smooth muscle cells
Function: Vasoconstriction, increases renal tubular sodium reabsorption
α2 Receptors:
Location: Presynaptic membranes of postganglionic nerve terminals
Function: Inhibit norepinephrine release (negative feedback)
β1 Receptors:
Function: Increase cardiac contraction rate and strength, increase cardiac output, stimulate renin release in the kidney
β2 Receptors:
Function: Relax vascular smooth muscle, leading to vasodilation

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17
Q

Activation of which receptor type is associated with increased renin release from the kidney?
A) α1
B) α2
C) β1
D) β2

A

C

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18
Q

What is the primary effect of β2 receptor activation?
A) Vasoconstriction of smooth muscle
B) Increased cardiac output
C) Vasodilation of vascular smooth muscle
D) Sodium reabsorption in the kidney

A

C

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19
Q

Which of the following conditions may result in tachyphylaxis due to adrenergic receptor downregulation?
A) Chronic low levels of catecholamines
B) Chronic high levels of catecholamines
C) Chronic use of adrenergic antagonists
D) Intermittent use of adrenergic antagonists

A

B

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20
Q

A patient with pheochromocytoma presents with orthostatic hypotension. What is the most likely cause?
A) Increased β2 receptor activation
B) Increased norepinephrine release
C) Lack of norepinephrine-induced vasoconstriction in response to standing
D) Overactivation of α2 receptors

A

C

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21
Q

What is the primary mechanism by which clonidine, a centrally acting α2 agonist, lowers blood pressure?
A) Inhibition of renin release from the kidney
B) Decreased sympathetic outflow
C) Increased cardiac output
D) Vasoconstriction of peripheral blood vessels

A

B

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22
Q

Which reflex mechanism primarily buffers acute fluctuations in blood pressure during postural changes?
A) Sympathetic outflow from the spinal cord
B) Arterial baroreflex mediated by stretch-sensitive receptors
C) Chemoreceptor reflex in the brainstem
D) β2 receptor activation by circulating catecholamines

A

B

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23
Q

A patient treated with clonidine abruptly stops the medication and experiences a significant spike in blood pressure. What is the most likely cause of this rebound hypertension?
A) Upregulation of α1 receptors
B) Downregulation of β1 receptors
C) Increased renin release
D) Decreased norepinephrine levels

A

A

Abrupt cessation of clonidine, a centrally acting α2 agonist, can cause rebound hypertension due to upregulation of α1 receptors, leading to increased sensitivity to sympathetic stimuli.

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24
Q

What reflex is responsible for buffering acute fluctuations in blood pressure during postural changes?

A

Arterial baroreflex: Adjusts sympathetic outflow to decrease blood pressure during fluctuations

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25
Q

Regulates arterial pressure through vasoconstriction (angiotensin II) and sodium retention (aldosterone).

A

RAAS

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26
Q

Three Primary Stimuli for Renin Secretion

A

> Decreased NaCl transport in the thick ascending limb of the loop of Henle (macula densa).
Decreased pressure/stretch in the renal afferent arteriole (baroreceptor mechanism).
Sympathetic nervous system stimulation of renin-secreting cells via β1 adrenoreceptors.

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27
Q

Renin secretion is
inhibited by:

A

> Increased NaCl transport in the thick ascending limb of the loop of Henle.
Increased stretch within the renal afferent arteriole.
β1 receptor blockade.

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28
Q

Angiotensinogen: Cleaved by ___ to form angiotensin I (inactive decapeptide).

A

renin

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29
Q

This converts angiotensin I to angiotensin II (active octapeptide) primarily in pulmonary circulation.

A

ACE

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30
Q

The primary tropic factor regulating the synthesis and secretion of aldosterone by the zona glomerulosa of the adrenal cortex

A

Angiotensin II

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31
Q

A potent mineralocorticoid that increases sodium reabsorption via amiloride-sensitive epithelial sodium channels (ENaC) on the apical surface of principal cells in the renal cortical collecting duct.

A

Aldosterone

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32
Q

A condition of mineralocorticoid-mediated hypertension where adrenal aldosterone synthesis and release are independent of renin-angiotensin.

A

Primary Aldosteronism

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33
Q

Prevents aldosterone-induced myocardial fibrosis.
Reduces the risk of heart failure progression and cardiac death in CHF.

A

Spironolactone

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34
Q

The most common cause of death in hypertensive patients

A

Heart Disease

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35
Q

This provides a noninvasive estimate of target organ injury and is associated with cardiovascular events

A

Coronary Artery Calcium Score

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36
Q

The strongest risk factor for stroke

A

Elevated blood pressure

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36
Q

Provides the most accurate assessment of diastolic function.

A

Cardiac catheterization

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37
Q

Hypertension is associated with ____ deposition, a major pathologic factor in dementia

A

beta amyloid

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38
Q

Which of the following stimuli triggers renin secretion?
A) Increased NaCl transport in the thick ascending limb of the loop of Henle
B) Decreased pressure or stretch in the renal afferent arteriole
C) Decreased sympathetic nervous system activity
D) Angiotensin II receptor activation

A

B

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39
Q

Which of the following describes the primary function of aldosterone in the renal system?
A) Increase calcium reabsorption
B) Decrease potassium secretion
C) Increase sodium reabsorption via ENaC channels
D) Inhibit renin release

A

C

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40
Q

How does angiotensin II affect renin secretion?
A) Stimulates renin release via AT1 receptors
B) Inhibits renin secretion via AT1 receptors
C) Stimulates renin release via AT2 receptors
D) Has no effect on renin secretion

A

B

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41
Q

Which enzyme is responsible for converting angiotensin I into angiotensin II?
A) Renin
B) Angiotensinogen
C) Aldosterone
D) Angiotensin-converting enzyme (ACE)

A

D

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42
Q

What is the role of AT2 receptors in the renin-angiotensin-aldosterone system (RAAS)?
A) Induce vasoconstriction and increase blood pressure
B) Inhibit sodium excretion and stimulate aldosterone release
C) Promote vasodilation and sodium excretion
D) Stimulate renin release and increase vascular remodeling

A

C

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43
Q

How does potassium influence aldosterone secretion?
A) Potassium inhibits aldosterone synthesis
B) Aldosterone synthesis is dependent on potassium levels
C) Potassium decreases aldosterone release
D) Aldosterone secretion is independent of potassium

A

B

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44
Q

What is the primary cause of primary aldosteronism?
A) Overactivation of the renin-angiotensin system
B) Independent adrenal aldosterone production
C) Increased sodium excretion
D) Decreased sympathetic nervous system activity

A

B

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45
Q

How does aldosterone impact electrolyte balance?
A) Increases calcium retention and decreases sodium excretion
B) Increases sodium reabsorption and promotes potassium and hydrogen ion excretion
C) Increases sodium and calcium excretion
D) Decreases potassium excretion and increases magnesium reabsorption

A

B

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46
Q

What role does aldosterone play in cardiovascular pathology?
A) Reduces blood pressure through vasodilation
B) Contributes to myocardial fibrosis and left ventricular hypertrophy
C) Prevents vascular inflammation and remodeling
D) Inhibits sodium reabsorption in the kidneys

A

B

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47
Q

Diagnostic of PAD, indicating >50% stenosis in at least one major lower limb artery.

A

ABI <0.9

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48
Q

An ankle-brachial index ___ is associated with elevated blood pressure, particularly systolic blood pressure.

A

<0.80

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49
Q

Cardiovascular disease risk doubles for every__-mmHg increase in systolic and __-mmHg increase in diastolic pressure.

A

20
10

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50
Q

Clinical criteria for defining hypertension generally have been based on the average of___ seated blood pressure readings during each of ___outpatient visits

A

two or more
two or more

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51
Q

___ is generally accepted as the best out-of-office measurement

A

Ambulatory monitoring

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52
Q

What is the current definition of hypertension according to recent guidelines?
A) Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg
B) Systolic blood pressure ≥120 mmHg or diastolic blood pressure ≥80 mmHg
C) Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg
D) Systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥90 mmHg

A

C

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53
Q

Which of the following tools is used to diagnose peripheral arterial disease (PAD) and assess cardiovascular risk?
A) Ankle-brachial index (ABI)
B) Carotid intima-media thickness
C) Coronary artery calcium score
D) Echocardiogram

A

A

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54
Q

Which of the following is a characteristic of “white coat hypertension”?
A) Normal office blood pressure and elevated ambulatory blood pressure
B) Elevated office blood pressure and normal ambulatory blood pressure
C) Both office and ambulatory blood pressures are elevated
D) Ambulatory blood pressure is lower than home blood pressure

A

B

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55
Q

What is the primary advantage of using ambulatory blood pressure monitoring (ABPM) over office blood pressure measurements?
A) It requires fewer readings than office measurements
B) It predicts target organ damage more reliably than office blood pressures
C) It is more cost-effective than office-based monitoring
D) It does not measure nighttime blood pressures

A

B

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56
Q

What is the significance of an attenuated nighttime blood pressure dip in hypertensive patients?
A) It is associated with a reduced risk of cardiovascular disease
B) It predicts lower rates of stroke and myocardial infarction
C) It is associated with increased cardiovascular disease risk
D) It indicates white coat hypertension

A

C

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57
Q

Which of the following is true about “masked hypertension”?
A) It is associated with elevated office blood pressure and normal ambulatory readings
B) It carries a lower risk of cardiovascular disease than normotension
C) It is characterized by normal office blood pressure but elevated out-of-office readings
D) It affects only about 1–5% of the population

A

C

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58
Q

How is hypertension in children and adolescents generally defined?
A) Systolic blood pressure ≥130 mmHg
B) Diastolic blood pressure ≥80 mmHg
C) Blood pressure consistently >95th percentile for age, sex, and height
D) Blood pressure >120/80 mmHg on two consecutive visits

A

C

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59
Q

Which of the following is a more practical method than ambulatory blood pressure monitoring (ABPM) for confirming and managing hypertension?
A) Clinic-based blood pressure measurement
B) Invasive blood pressure monitoring
C) Home blood pressure monitoring
D) Pulse oximetry

A

C

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60
Q

Primary OR secondary hypertension?

No identifiable cause; includes patients with obesity and metabolic syndrome, accounts for 80-95% of cases

A

Primary

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61
Q

Primary OR secondary hypertension?

Identifiable underlying disorder causing blood pressure elevation, represents 5-20% of cases

A

Secondary

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62
Q

Primary OR secondary hypertension?

It tends to be familial and is likely the result of an interaction between environmental and genetic factors.

A
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63
Q

____-renin patients may have a vasoconstrictor form of hypertension.
____-renin patients may have volume-dependent hypertension.

A

High
Low

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64
Q

Primary HTN

In the majority of patients with established hypertension:
Peripheral resistance is ____.
Cardiac output is either normal or decreased.
In younger patients with mild or labile hypertension:
Cardiac output may be increased.
Peripheral resistance may be ____.

A

Increased
Normal

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65
Q

Which of the following is the strongest determinant of blood pressure elevation in individuals with obesity?
A) Peripheral body fat
B) Subcutaneous fat
C) Centrally located body fat
D) Visceral fat

A

C

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66
Q

What is the relationship between body mass index (BMI) and blood pressure according to cross-sectional studies?
A) Inverse correlation
B) No correlation
C) Direct linear correlation
D) Exponential correlation

A

C

67
Q

Which of the following is not typically part of the metabolic syndrome?
A) Insulin resistance
B) Dyslipidemia
C) Hypertension
D) Peripheral fat distribution

A

D

Metabolic syndrome is characterized by insulin resistance, abdominal obesity, hypertension, and dyslipidemia. Peripheral fat distribution is not part of the typical profile for metabolic syndrom

68
Q

Which of the following is a surrogate marker of insulin resistance?
A) Hyperkalemia
B) Hypocalcemia
C) Hyperinsulinemia
D) Hypernatremia

A

C

69
Q

What role does insulin play in contributing to hypertension?
A) Promotes sodium retention
B) Decreases vascular tone
C) Inhibits platelet aggregation
D) Reduces cardiac output

A

A

70
Q

Insulin has an ___effect, which can contribute to the development of hypertension by promoting sodium retention.

A

antinatriuretic

71
Q

The most common cause of secondary hypertension.

A

Renal disease

72
Q

Proteinuria _____ and the presence of an active urine sediment are indicative of primary renal disease.

A

> 1000 mg/d

73
Q

______ accounts for the large majority of patients with renovascular hypertension.

A

Atherosclerosis

74
Q

The lesions of fibromuscular dysplasia are frequently ____ and, in contrast to atherosclerotic renovascular disease, tend to affect more distal portions of the renal artery.

A

bilateral

75
Q

What imaging modality is considered the “gold standard” for evaluating and identifying renal artery lesions?
A) Doppler ultrasound
B) Gadolinium-contrast magnetic resonance angiography
C) CT angiography
D) Contrast arteriography

A

D

76
Q

Which of the following factors suggests a functionally significant renal artery lesion?
A) Lesion that occludes 40% of the renal artery lumen
B) Presence of collateral vessels to the ischemic kidney on angiography
C) Non-lateralizing renal vein renin ratio
D) Mild hypertension with stable renal function

A

B

Collateral vessels to the ischemic kidney on angiography suggest a functionally significant lesion, which usually occludes >70% of the renal artery lumen.

77
Q

In which patient population is vascular repair most likely to be beneficial?
A) Elderly patients with advanced renal insufficiency
B) Patients with fibromuscular dysplasia
C) Patients with long-standing hypertension and diabetes mellitus
D) Patients with well-controlled blood pressure on medical therapy

A

B

Patients with fibromuscular dysplasia tend to have more favorable outcomes with vascular repair due to their younger age, shorter duration of hypertension, and less systemic disease compared to patients with atherosclerosis.

78
Q

What is the most effective medical therapy for renovascular hypertension?
A) Beta-blockers
B) Calcium channel blockers
C) ACE inhibitors or angiotensin II receptor blockers (ARBs)
D) Thiazide diuretics

A

C

ACE inhibitors or ARBs are considered the most effective medical therapies for renovascular hypertension but must be used with caution in patients with bilateral renal artery stenosis.

79
Q

Why should ACE inhibitors or ARBs be used cautiously in patients with bilateral renal artery stenosis?
A) They increase the risk of heart failure
B) They decrease glomerular filtration rate due to efferent arteriolar dilation
C) They lead to worsening hypertension
D) They increase renin production

A

B

ACE inhibitors and ARBs decrease glomerular filtration rate in patients with bilateral renal artery stenosis because of efferent renal arteriolar dilation, which can result in progressive renal insufficiency.

80
Q

What is the typical predictive value of a lateralizing renal vein renin ratio (>1.5 affected side/contralateral side) for identifying a lesion that would respond to vascular repair?
A) 50%
B) 70%
C) 90%
D) 100%

A

C

81
Q

It involves excess aldosterone production that is independent of the renin-angiotensin system.

A

Primary Aldosteronism

82
Q

What is the key difference between primary aldosteronism and secondary aldosteronism?
A) Primary aldosteronism is due to an adrenal tumor, while secondary aldosteronism is due to renal artery stenosis
B) Primary aldosteronism is independent of the renin-angiotensin system, while secondary aldosteronism is dependent on it
C) Primary aldosteronism is caused by high renin levels, while secondary aldosteronism is caused by low renin levels
D) Primary aldosteronism is associated with hyperkalemia, while secondary aldosteronism is associated with hypokalemia

A

B

83
Q

The consequences of primary aldosteronism are ___

A

sodium retention
hypertension hypokalemia
low PRA, cardiovascular disease
kidney damage

84
Q

What is considered a positive plasma aldosterone (PA) to plasma renin activity (PRA) ratio that strongly suggests an aldosterone-producing adenoma?
A) PA/PRA ratio >10:1
B) PA/PRA ratio >30:1 and PA >555 pmol/L (>20 ng/dL)
C) PA/PRA ratio >5:1 and PA <10 ng/dL
D) PA/PRA ratio <10:1 with elevated renin

A

B

A PA/PRA ratio >30:1 along with a plasma aldosterone concentration >555 pmol/L (>20 ng/dL) has a high sensitivity and specificity for aldosterone-producing adenoma.

85
Q

What is the significance of the aldosterone/cortisol ratio in adrenal venous sampling for primary aldosteronism?
A) It identifies patients with adrenal carcinoma
B) It distinguishes between unilateral and bilateral aldosterone secretion
C) It confirms the presence of adrenal hyperplasia
D) It rules out primary aldosteronism if the ratio is elevated

A

B

86
Q

What is the typical hormonal pattern in aldosterone-producing adenomas related to the diurnal rhythm?
A) Higher plasma aldosterone in the afternoon
B) Higher plasma aldosterone in the early morning, decreasing throughout the day
C) Lower aldosterone levels in the morning
D) Aldosterone levels remain constant throughout the day

A

B

87
Q

In hypertensive patients with unprovoked ______ (i.e., unrelated to diuretics, vomiting, or diarrhea), the prevalence of primary aldosteronism approaches 40–50%

A

hypokalemia

88
Q

The ratio of plasma aldosterone (PA) to PRA (PA/PRA) is a useful screening test is preferably obtained in ambulatory patients in the ____.

A

morning

89
Q

Aldosterone biosynthesis is ____-dependent

A

potassium

90
Q

Withdraw aldosterone antagonists for at least ___ before obtaining PA/PRA measurements

A

4–6 weeks

91
Q

The two most common causes of sporadic primary aldosteronism are an___and ___.

A

aldosterone-producing adenoma
bilateral adrenal hyperplasia

92
Q

Aldosterone biosynthesis is more responsive to ___ in patients with adenoma and more responsive to ____ in patients with hyperplasia.

A

ACTH
angiotensin

93
Q

Adrenal computed tomography (CT) should be carried out in all patients diagnosed with primary aldosteronism. T/F

A

T

94
Q

Which of the following mechanisms is primarily responsible for the development of hypertension in patients with Cushing’s syndrome?
A) Increased aldosterone production
B) Increased stimulation of mineralocorticoid receptors by cortisol
C) Decreased cortisol production
D) Increased renin secretion

A

B

95
Q

The definitive treatment of pheochromocytoma and results in cure in ~90% of patients.

A

Surgical excision

96
Q

What is the primary cause of hypertension in patients with pheochromocytoma?
A) Increased aldosterone secretion
B) Increased circulating catecholamines
C) Increased cortisol secretion
D) Sodium retention

A

B

97
Q

Most common congenital cardiovascular cause of hypertension.

A

Coarctation of the Aorta

98
Q

Hypertension due to ___ should be considered in patients with:
Drug-resistant hypertension
A history of snoring.

A

OSA

99
Q

Mild diastolic hypertension may be a consequence of __, whereas __ may result in systolic hypertension

Hypo/hyperthyroidism.

A

hypothyroidism
hyperthyroidism

100
Q

Recommended laboratory tests in the initial evaluation of hypertensive patients.

A
101
Q

What is recommended for accurate blood pressure measurement at the first visit?
A) Measure blood pressure once in the right arm only
B) Measure blood pressure in both arms and use the higher reading for subsequent measurements
C) Measure blood pressure in the lower extremities
D) Use a mercury sphygmomanometer

A

B

102
Q

Which of the following is a sign of possible pseudohypertension in older patients?
A) Elevated blood pressure in both arms
B) A palpable radial pulse despite cuff occlusion of the brachial artery
C) A systolic pressure difference between the arms
D) Diastolic blood pressure >120 mmHg

A

B

103
Q

Which of the following is true about “masked hypertension”?
A) It is associated with elevated office blood pressure and normal ambulatory readings
B) It carries a lower risk of cardiovascular disease than normotension
C) It is characterized by normal office blood pressure but elevated out-of-office readings
D) It affects only about 1–5% of the population

A

C

104
Q

Which of the following is a characteristic of “white coat hypertension”?
A) Normal office blood pressure and elevated ambulatory blood pressure
B) Elevated office blood pressure and normal ambulatory blood pressure
C) Both office and ambulatory blood pressures are elevated
D) Ambulatory blood pressure is lower than home blood pressure

A

B

105
Q

The single most effective intervention for slowing the rate of progression of hypertension-related kidney disease.

A

Hypertension control

106
Q

Which of the following is the most effective intervention for slowing the progression of hypertension-related kidney disease?
A) Blood pressure control
B) Sodium restriction
C) Fluid management
D) Weight loss

A

A

107
Q

Lowering systolic blood pressure by ____ mmHg and diastolic blood pressure by ___ mmHg confers relative risk reductions of 35–40% for stroke and 12–16% for CHD within 5 years of the initiation of treatment.

A

10-12
5–6

108
Q

Which of the following lifestyle modifications has the most significant impact on preventing the development of hypertension?
A) Potassium supplementation
B) Reduction of dietary NaCl
C) Reduction in alcohol consumption
D) Calcium supplementation

A

B

109
Q

The Dietary Approaches to Stop Hypertension (DASH) trial demonstrated that a diet high in fruits, vegetables, and low-fat dairy products can lower blood pressure. What additional dietary modification was found to augment the effect of this diet on blood pressure?
A) Reducing alcohol consumption
B) Reducing daily NaCl intake to <6 g
C) Increasing potassium supplementation
D) Reducing calcium intake

A

C

110
Q

Thiazides inhibit the ____ pump in the _____, increasing sodium excretion. Over the long term, they may also act as vasodilators.

A

Na+/Cl–

distal convoluted tubule

111
Q

Inhibit the Na+-K+-2Cl– cotransporter in the thick ascending limb of the loop of Henle.

A

Loop diuretics

112
Q

Inhibit ENaC (epithelial sodium channels) in the distal nephron.

A

Potassium-Sparing Diuretics

113
Q

What is the main pharmacologic target for loop diuretics?
A) Na+/Cl– pump in the distal convoluted tubule
B) Na+/K+/2Cl– cotransporter in the thick ascending limb of the loop of Henle
C) ENaC channels in the distal nephron
D) Angiotensin-converting enzyme (ACE)

A

B

114
Q

What is the mechanism by which ACE inhibitors (ACEIs) lower blood pressure?
A) Blocking AT1 receptors
B) Inhibiting the Na+/K+ ATPase pump
C) Decreasing the production of angiotensin II and increasing bradykinin levels
D) Blocking calcium channels

A

C

115
Q

Which antihypertensive class has been shown to reduce the risk of developing diabetes in high-risk hypertensive patients compared to amlodipine?
A) Calcium channel blockers
B) Beta-blockers
C) ACE inhibitors
D) Angiotensin II receptor blockers (ARBs)

A

D

116
Q

Why is combination ACEI/ARB therapy not recommended in patients with vascular disease or a high risk of diabetes?
A) It leads to a significant increase in blood pressure
B) It is associated with more adverse events without additional benefit
C) It causes severe electrolyte imbalances
D) It is less effective than monotherapy

A

C

117
Q

In patients with CHF, low-dose ___ reduces mortality and hospitalizations for heart failure when given in addition to conventional therapy with ACEIs, digoxin, and loop diuretics.

A

spironolactone

118
Q

It reduces vascular resistance through L-channel blockade, which reduces intracellular calcium and blunts vasoconstriction.

A

Calcium antagonists

119
Q

There is no difference in antihypertensive potency between cardioselective and nonselective beta blockers. T/F

A

T

120
Q

___ are particularly effective in hypertensive patients with tachycardia, and their hypotensive potency is enhanced by co-administration with a diuretic.

A

Beta blockers

121
Q

In lower doses, some beta blockers selectively inhibit cardiac β 1 receptors and have less influence on β 2 receptors on bronchial and vascular smooth muscle cells T/F

A

T

122
Q

____reduce the risks of hospitalization and mortality in patients with CHF.

A

Beta blockers

123
Q

Effective in treating lower urinary tract symptoms in men with prostatic hypertrophy.

A

α-Adrenergic Blockers

124
Q

Lower blood pressure by decreasing peripheral vascular resistance.

A

α-Adrenergic Blockers

125
Q

Useful in: Patients with autonomic neuropathy who have wide blood pressure variations due to baroreceptor denervation.

A

Centrally Acting α2 Sympathetic Agonists

126
Q

Which of the following is a known side effect of ACE inhibitors (ACEIs)?

A) Hyperkalemia
B) Hypoglycemia
C) Hypotension
D) Bradycardia

A

A

127
Q

What is a primary reason beta blockers reduce blood pressure?

A) Increasing sodium excretion
B) Decreasing cardiac output
C) Stimulating renin release
D) Inhibiting bradykinin production

A

B

Beta blockers lower blood pressure by reducing heart rate and contractility, thus decreasing cardiac output.

128
Q

Which of the following calcium channel blocker classes is most likely to cause flushing, headache, and edema?

A) Phenylalkylamines
B) Benzothiazepines
C) 1,4-dihydropyridines
D) Non-dihydropyridines

A

C

Dihydropyridines, such as nifedipine, are potent arteriolar dilators and commonly cause side effects like flushing, headache, and edema.

129
Q

Which of the following is true regarding the use of ARBs (angiotensin receptor blockers)?

A) They block angiotensin II at AT2 receptors
B) They reduce bradykinin levels
C) They selectively block AT1 receptors
D) They increase insulin resistance

A

C

130
Q

Which sympatholytic agent is most likely to cause rebound hypertension upon abrupt cessation?

A) Beta blockers
B) Centrally acting alpha-2 agonists
C) Peripheral sympatholytics
D) Alpha-adrenergic blockers

A

B

131
Q

What is the primary mechanism of action of direct vasodilators like hydralazine?

A) Increasing sodium retention
B) Blocking calcium channels
C) Decreasing peripheral resistance
D) Reducing sympathetic outflow

A

C

Direct vasodilators like hydralazine decrease peripheral resistance, which leads to vasodilation and a reduction in blood pressure.

132
Q

Which of the following antihypertensive classes is likely to be more effective in a younger patient?
A) Thiazide diuretics
B) Calcium antagonists
C) ACE inhibitors (ACEIs)
D) Alpha-blockers

A

C

133
Q

What was a key finding of the ALLHAT trial regarding peripherally acting alpha antagonists like doxazosin?
A) They significantly reduced the risk of heart failure compared to diuretics.
B) They were superior to beta blockers in preventing cardiovascular events.
C) The trial involving doxazosin was terminated early due to a higher incidence of heart failure and stroke.
D) Doxazosin was more effective than calcium antagonists in reducing stroke risk.

A

C

134
Q

Which combination of antihypertensive agents was found to be superior in reducing cardiovascular events and death among high-risk patients in the ACCOMPLISH trial?
A) ACEI (benazepril) plus a calcium antagonist (amlodipine)
B) ACEI plus beta blocker
C) ACEI plus diuretic (hydrochlorothiazide)
D) Calcium antagonist plus beta blocker

A

A

The ACCOMPLISH trial showed that the combination of an ACEI (benazepril) and a calcium antagonist (amlodipine) was superior to ACEI and a diuretic in reducing cardiovascular events and death among high-risk hypertensive patients.

135
Q

In patients with hypertension and heart failure due to systolic dysfunction, which combination of drugs has been shown to improve survival?
A) Thiazide diuretics and calcium channel blockers
B) ACEIs or ARBs, diuretics, and beta blockers
C) Alpha-blockers and ARBs
D) ACEIs and calcium channel blockers

A

B

136
Q

Which antihypertensive class is inferior to other classes for preventing cardiovascular events, stroke, renal failure, and all-cause mortality?
A) Calcium channel blockers
B) Beta blockers
C) ACE inhibitors
D) Thiazide diuretics

A

B

137
Q

What is a potential renal benefit of ACE inhibitors in both diabetic and non-diabetic renal diseases?
A) Increasing plasma renin activity
B) Increasing glomerular pressure
C) Reducing proteinuria and slowing the progression of renal insufficiency
D) Enhancing sodium reabsorption in the renal tubules

A

C

ACE inhibitors reduce intraglomerular pressure and proteinuria, which can slow the progression of renal insufficiency in both diabetic and non-diabetic renal diseases.

138
Q

Which combination therapy has been reported to reduce the rate of recurrent stroke in hypertensive patients?
A) ARB and diuretic
B) ACEI and beta blocker
C) ACEI and diuretic
D) Beta blocker and calcium channel blocker

A

C

139
Q

Which emerging nonpharmacologic antihypertensive therapy has shown no benefit on blood pressure compared to a sham procedure in the Simplicity HTN-3 trial?
A) Carotid baroreflex activation
B) Renal sympathetic denervation
C) Endovascular balloon angioplasty
D) Renal artery stenting

A

B

140
Q

Resistant hypertension is defined as blood pressure persistently >____mmHg despite taking ____antihypertensive agents, including a diuretic.

A

140/90

three or more

141
Q

2017 ACC/AHA guidelines recommend a blood pressure target of <___ mmHg for primary and secondary prevention, including in patients with diabetes and chronic kidney disease.

A

130/80

142
Q

Which of the following systolic and diastolic blood pressure ranges provides maximum protection against combined cardiovascular endpoints?
A) <140/90 mmHg
B) <135–140/80–85 mmHg
C) <130/80 mmHg
D) <120/70 mmHg

A

B

143
Q

Which trial demonstrated a 25% reduction in cardiovascular events and mortality with intensive blood pressure control (systolic blood pressure <120 mmHg) in individuals at increased cardiovascular risk?
A) ACCORD trial
B) ALLHAT trial
C) SPRINT trial
D) Simplicity HTN-3 trial

A

C

144
Q

In diabetic patients, which of the following outcomes was significantly reduced with intensive blood pressure therapy (<120 mmHg) in the ACCORD trial?
A) Myocardial infarction
B) Stroke
C) Cardiovascular death
D) Heart failure

A

B

The ACCORD trial did not show superiority of intensive therapy (<120 mmHg) over standard therapy (<140 mmHg) for myocardial infarction, stroke, and cardiovascular death. However, intensive therapy did show significant reduction in stroke.

145
Q

Which of the following is an appropriate target blood pressure for older patients (>80 years of age) with isolated systolic hypertension according to recent guidelines?
A) <120/80 mmHg
B) <140/90 mmHg
C) 130–150 mmHg systolic
D) <110/70 mmHg

A

C

145
Q

According to the 2017 ACC/AHA guidelines, what is the recommended blood pressure target for the prevention of cardiovascular disease in patients with diabetes mellitus and chronic kidney disease?
A) <140/90 mmHg
B) <130/85 mmHg
C) <130/80 mmHg
D) <120/80 mmHg

A

C

146
Q

What is the term for blood pressure that remains >140/90 mmHg despite the use of three or more antihypertensive agents, including a diuretic?
A) Resistant hypertension
B) Pseudohypertension
C) White coat hypertension
D) Labile hypertension

A

A

147
Q

In patients with resistant hypertension, which class of drugs has been demonstrated as the most effective add-on therapy?
A) Calcium channel blockers
B) Beta blockers
C) Mineralocorticoid receptor antagonists
D) Alpha-blockers

A

C

148
Q

What differentiates a hypertensive urgency from a hypertensive emergency?
A) Degree of blood pressure elevation
B) Presence of target organ damage
C) Duration of hypertension
D) Use of monoamine oxidase inhibitors

A

B

149
Q

Which of the following is a potential risk of overly aggressive lowering of blood pressure in hypertensive emergencies?
A) Increased sympathetic outflow
B) Cerebral ischemia due to decreased cerebral blood flow
C) Enhanced coronary blood flow
D) Rapid resolution of malignant hypertension

A

B

150
Q

What is the initial target for blood pressure reduction in hypertensive emergencies with encephalopathy?
A) Reduce blood pressure by 50% within 24 hours
B) Reduce mean arterial pressure by no more than 25% within minutes to 2 hours
C) Immediate normalization of blood pressure
D) Reduce blood pressure to 120/80 mmHg within 24 hours

A

B

151
Q

What is the recommended goal for initial blood pressure reduction in a patient presenting with hypertensive encephalopathy?
A) Reduce blood pressure by 50% within the first hour
B) Lower mean arterial pressure by no more than 25% within minutes to 2 hours
C) Lower systolic blood pressure to <100 mmHg immediately
D) Gradually lower blood pressure over 24 hours with oral agents

A

B

152
Q

What is the definition of hypertensive urgency?
A) Systolic blood pressure ≥160 mmHg without symptoms
B) Systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥120 mmHg without acute target organ damage
C) Diastolic blood pressure ≥100 mmHg with target organ damage
D) Systolic blood pressure ≥140 mmHg with symptoms

A

B

153
Q

What is the initial goal when treating a patient with hypertensive encephalopathy?
A) Reduce mean arterial pressure by no more than 25% within minutes to 2 hours
B) Lower systolic blood pressure to below 120 mmHg within 30 minutes
C) Increase diastolic pressure to above 110 mmHg
D) Lower blood pressure gradually over 48 hours

A

A

154
Q

Why is it important not to overly aggressively lower blood pressure in hypertensive emergencies?
A) It may cause an immediate increase in blood glucose levels
B) It can precipitate cerebral ischemia or infarction due to decreased cerebral blood flow
C) It increases the risk of pulmonary edema
D) It may lead to a rebound hypertension effect

A

B

155
Q

What is the recommended treatment approach for malignant hypertension without encephalopathy or catastrophic events?
A) Rapid reduction of blood pressure within 30 minutes
B) Immediate use of high-dose oral beta blockers
C) Gradual reduction of blood pressure over hours using short-acting oral agents
D) Avoid lowering blood pressure for at least 48 hours

A

C

155
Q

In a hypertensive urgency without acute target organ damage, blood pressure should be lowered:
A) Immediately to normal levels within 1 hour
B) Gradually over 24 hours to approximately 25% of the initial value
C) Only with diuretic therapy
D) To below 120/80 mmHg within 2 hours

A

B

156
Q

Which of the following medications is recommended for the immediate treatment of hypertensive encephalopathy?
A) Oral captopril
B) Intravenous nitroprusside
C) Oral amlodipine
D) Subcutaneous furosemide

A

B

157
Q

What is the primary concern with aggressive reduction of blood pressure after thrombotic or hemorrhagic strokes?
A) Renal failure
B) Impaired cerebral blood flow due to disrupted autoregulation
C) Increased risk of myocardial infarction
D) Pulmonary edema

A

B

Autoregulation of cerebral blood flow is impaired in ischemic cerebral tissue, and higher arterial pressures may be required to maintain cerebral perfusion.

158
Q

In patients with a systolic blood pressure ≥220 mmHg or a diastolic blood pressure ≥120 mmHg after a stroke, but who are not candidates for thrombolytic therapy, what is the suggested approach for blood pressure management?
A) Immediate reduction to <140/90 mmHg
B) Gradual reduction by 15% during the first 24 hours
C) Complete normalization of blood pressure within 6 hours
D) Avoiding any reduction in blood pressure

A

B

159
Q

For patients who will undergo thrombolytic therapy for ischemic stroke, the recommended goal for systolic blood pressure prior to initiation is:
A) <120 mmHg
B) <140 mmHg
C) <185 mmHg
D) <160 mmHg

A

C

Blood pressure should be reduced to <185 mmHg systolic pressure and <110 mmHg diastolic pressure before initiating thrombolytic therapy.

160
Q

Which of the following statements about blood pressure management after a hemorrhagic stroke is true?
A) Acute reduction to <120/80 mmHg is always beneficial
B) Continuous intravenous infusion should be considered for systolic BP >220 mmHg
C) No blood pressure lowering is needed
D) Diastolic pressure should be raised above 110 mmHg

A

B

161
Q

For neurologically stable patients after stroke, with a blood pressure >140/90 mmHg, which approach is suggested?
A) Delay starting antihypertensive therapy until the second week post-stroke
B) Start or restart antihypertensive therapy after the first 24 hours to improve long-term control
C) Avoid any antihypertensive therapy
D) Immediate initiation of three-drug combination therapy

A

B

162
Q

For neurologically stable patients after stroke, with a blood pressure >140/90 mmHg, which approach is suggested?
A) Delay starting antihypertensive therapy until the second week post-stroke
B) Start or restart antihypertensive therapy after the first 24 hours to improve long-term control
C) Avoid any antihypertensive therapy
D) Immediate initiation of three-drug combination therapy

A

B

For neurologically stable patients, it is reasonable to start or restart antihypertensive therapy after the first 24 hours to improve long-term blood pressure control.

163
Q

What is the treatment of choice for an adrenergic crisis related to catecholamine excess, such as cocaine or amphetamine overdose?
A) Propranolol
B) Phentolamine or nitroprusside
C) Lisinopril
D) Diltiazem

A

B

164
Q

Which of the following is NOT a recommended blood pressure goal in the management of a stroke patient with severe hypertension (>220/120 mmHg)?
A) Reduce systolic BP to <185 mmHg for thrombolytic candidates
B) Lower BP by 15% during the first 24 hours for non-thrombolytic candidates
C) Immediate reduction to <120/80 mmHg
D) Gradual BP reduction for hemorrhagic stroke patients with systolic BP >220 mmHg

A

C

Cardiology (10 decks)

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