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ABFM + KSA Hypertension V2 (Latest Update 2025 / 2026) Questions & Answers | Grade A | 100% Correct (Verified Answers)

Question:

You make a diagnosis of hypertension in a 69-year-old white female. Her past medical history is notable for osteoporosis and calcium oxalate kidney stones.Which one of the following would be most appropriate for managing this patient's hypertension?

• An ACE inhibitor
• An α1-blocker
• A β-blocker
• A calcium channel blocker
• A thiazide-type diuretic

Rationale:

In the general nonblack population, including those with diabetes mellitus, JNC 8 recommends that initial antihypertensive treatment should include a thiazide-type diuretic, a calcium channel blocker, an ACE inhibitor, or an angiotensin receptor blocker. Thiazide diuretics preserve hip and spine bone mineral density in older patients, and patients with hypertension and osteoporosis thus derive additional benefits from these agents. Thiazide diuretics also reduce renal excretion of calcium, providing added value in hypertensive patients with calcium oxalate stones. 1 / 4

Question:

Which one of the following antihypertensive agents has NOT been shown to be of benefit in a hypertensive patient with diabetes mellitus?

• Thiazide diuretics
• Angiotensin II receptor blockers
• α-Blockers
• Calcium channel blockers
• β-Blockers

Rationale:

Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors are reasonable first-line treatments for patients with type 2 diabetes mellitus.These have been shown to prevent adverse clinical outcomes (i.e., all-cause mortality, major cardiovascular events, cardiovascular mortality, and advanced microvascular problems, including retinopathy, nephropathy, and neuropathy). To a lesser degree, β-blockers and calcium channel blockers have also been shown to have proven efficacy compared to placebo. Although helpful in achieving desired blood pressure control, α-blockers have not been shown to reduce microvascular or macrovascular problems in patients with diabetes.

Question:

A patient with bipolar disorder that is well controlled by lithium is diagnosed with essential hypertension. Which of the following antihypertensive agents should be avoided because they can raise serum lithium levels? (Mark all that are true.)

• Hydrochlorothiazide
• Propranolol
• Clonidine (Catapres) 2 / 4

• Ramipril (Altace)
• Doxazosin (Cardura)

Rationale:

Diuretic-induced sodium loss can reduce the renal clearance of lithium, thereby increasing serum lithium levels and the risk of lithium toxicity. There is also evidence that ACE inhibitors can substantially increase steady-state plasma lithium levels and sometimes result in lithium toxicity. In a population-based, nested, case-control study, a 7.6-fold increased risk for lithium toxicity was seen within 1 month of starting an ACE inhibitor.

Question:

A 62-year-old male has had consistently elevated blood pressure at three consecutive visits. His past medical history is notable only for a history of a single episode of gout 9 months ago. He does not take any medications. A physical examination is normal except for a blood pressure of 145/92 mm Hg.Laboratory findings are within the normal range except for a serum uric acid level of 8.9 mg/dL (N 4.5-8.0).Which one of the following antihypertensive agents would also help to prevent future gout attacks by reducing the patient's uric acid levels?

• Furosemide (Lasix)
• Hydrochlorothiazide
• Lisinopril (Prinivil, Zestril)
• Losartan (Cozaar)
• Metoprolol succinate (Toprol-XL)

Rationale:

Losartan is the only angiotensin receptor blocker that has consistently been shown to lower serum uric acid levels, and there is evidence that it reduces 3 / 4

the risk for incidents of gout as well. Calcium channel blockers also appear to have urate-lowering properties and may also reduce the risk of gout. Thiazide diuretics, loop diuretics, and β-blockers have all been shown to raise uric acid levels. Furthermore, a higher risk for incident gout has been reported for patients treated with diuretics, β-blockers, ACE inhibitors, and angiotensin II receptors other than losartan.

Question:

Which of the following classes of antihypertensive agents have been shown to produce a regression of left ventricular hypertrophy? (Mark all that are true.)

• ACE inhibitors
• Direct vasodilators
• β-Blockers
• Calcium channel blockers
• Thiazide diuretics

Rationale:

In patients with left ventricular hypertrophy, studies have shown a reduction in left ventricular mass in those treated with ACE inhibitors, diuretics, calcium antagonists, and β-blockers, with the most consistent reduction achieved with ACE inhibitors and the least with β-blockers. Regression of left ventricular hypertrophy has not been demonstrated with direct vasodilators such as hydralazine and minoxidil.

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