Cardiometabolic disease affects 1 out of every 2 Americans today. This first of 4 quizzes tests your knowledge of how to manage hypertension, heart failure, and renal disease.
Cardiometabolic disease is a cluster of interrelated metabolic dysfunctions that leads to chronic and frequently fatal conditions including cardiovascular diseases, such as coronary heart disease, stroke, and hypertension, as well as metabolic diseases, such as type 2 diabetes, obesity and non-alcoholic fatty liver disease.
Find out what you know about guideline recommendations surrounding hypertension, heart failure, and renal disease in Quiz #1 in our series of 4 on cardiometabolic disease.
Abbreviations used throughout: ACC/AHA, American College of Cardiology/American Heart Association; HTN, hypertension; BP, blood pressure; CV, cardiovascular; HF, heart failure; CKD, chronic kidney disease
1. Which of the options above does the the 2017 ACC/AHA guideline HTN recommend for the management of HTN in older adults?
Answer: A. If aged ≥65 with HTN, treat to the same target as young adults (130/80 mmHg). The 2017 ACC/AHA HTN guideline lowered the BP value for a diagnosis of HTN. More intensive HTN management is now recommended regardless of age, including treating adults aged ≥65 to the same target as younger adults unless comorbidities are high and life expectancy low.
Intensity of antihypertensive therapy in the latter case is based on a risk/benefit analysis.
American College of Physicians/American Academy of Family Physicians. Note: The 2017 ACP/AFP HTN guidelines for adults aged ≥60 recommend starting medication when systolic BP is persistently elevated≥150 mmHg and treating to a target of <150 mmHg systolic.
In individuals with a history of stroke or TIA or who are at high CV risk, target 140 mmHg systolic.
2. According to the 2017 ACC/AHA guideline on HTN in adults, which of the above is not a risk factor for secondary HTN?
Answer B. 4.5 mmol/L = normokalemic in HF. According to an expert review of abnormalities of potassium in HF by American College of Cardiology, clinically relevant hypokalemia is <3.5 mmol/L and is most frequently caused by use of diuretics. Prognosis for dyskalemia follows U-shaped curve, with worse outcomes such as cardiac arrythmias and cardiovascular death at both ends of the spectrum.
4. A 55-year-old African American man is in clinic for follow-up of persistently elevated BP of 140/90 as measured at home. His BP has failed to respond to weight loss, dietary modification, and increased physical activity; HF, CKD, and other causes of secondary HTN have been ruled out. According 2017 ACC/AHA HTN guidelines, first line antihypertensive therapy for him should be which of the above?
Answer: D. Both A. Hydrochlorothiazide and C. Amlodipine. Findings from the MESA study indicate that African American adults have a higher lifetime risk for HTN vs other racial/ethnic groups.
Most Adults Need 2 Antihypertensive Agents. In African American adults with HTN without HF or CKD, 2017 ACC/AHA HTN guidelines recommend initial antihypertensive therapy with a thiazide-type diuretic (eg, hydrochlorothiazide) or a calcium channel blocker (eg, amlodipine.) The guidelines note that most adults will require ≥2 antihypertensive medications to achieve the recommended goal of <130/80 mmHg.