1. You have been referred to a 65-year-old man whom the GP has struggled to manage. For the last year, his clinic blood pressure recordings have been persistently around 150/90 mmHg. Still, he claims to suffer from the ‘white coat’ phenomenon, with home recordings of about 135/90 mmHg which you are satisfied to have been undertaken appropriately. He is otherwise healthy, having implemented dietary changes and increased his exercise over the last year, but smokes and intends to continue.
What do you recommend?

• A clinic recording, which if normal suggests no need for medical management and if >140/90 mmHg requires treatment.
• A 24-hour ambulatory blood pressure monitor (ABPM).
• Salt restriction, exercise, and continued home monitoring.
• Commencement of pharmacological treatment.
• Home devices are not as reliable as a mercury sphygmomanometer; therefore the clinic measurements should be believed and treatment commence.

2. You requested a 24-hour ambulatory blood pressure monitor to assess an individual’s response to treatment. It revealed an average daytime recording of 143/95 mmHg and a night-time average of 134/80 mmHg. He is aged 57, is non-diabetic, and has appropriately adjusted his lifestyle. Medication was commenced a year ago, and he has been on 5 mg of ramipril for 3 months with a recently tolerated mild cough, which may be unrelated.
What is the best treatment option?

• Review lifestyle modification, including weight loss.
• Increase the ramipril to 7.5 mg.
• Add an angiotensin receptor blocker.
• Add a beta-blocker.
• Add a calcium-channel antagonist.

3. A patient is followed up at a 6-week appointment following a primary percutaneous intervention for an anterior STEMI. An echocardiogram pre-discharge estimated overall LVEF as 40%. He is asymptomatic, compliant with all medications, and has no problems from side effects. His blood pressure is 95/70 mmHg, with no evidence of a postural drop, and his heart rate is 55 bpm. His GP has recently increased his medication to 5 mg bisoprolol and 7.5 mg ramipril.
What are your recommendations?

• Continue on the current regime.
• Reduce ramipril to 5 mg.
• Reduce bisoprolol to 2.5 mg.
• Reduce both medications.
• Repeat echocardiogram to assess the left ventricle and then decide the treatment regimen.

4. Which one of the following antihypertensive medications might you use to try and prevent new-onset atrial fibrillation?

• Atenolol
• Amlodipine
• Bisoprolol
• Digoxin
• Losartan

5. Which of the following antihypertensive drug classes is most effective at reducing carotid intimal thickness?

• Calcium channel blocker
• β-Blocker
• ACEI
• Thiazide diuretic

6. What is the long-term antihypertensive mechanism of action for thiazide diuretics?

• Decreased plasma volume
• Natriuresis
• Decreased cardiac output
• Decreased peripheral resistance

7. A 56-year-old man on hydralazine, hydrochlorothiazide, lisinopril, and metoprolol begins to develop a malar rash and arthralgias. Which of the above antihypertensive agents is known to cause drug-induced lupus?

• Hydralazine
• Hydrochlorothiazide
• Lisinopril
• Metoprolol

8. A 27-year-old woman presents to the cardiology clinic for evaluation of uncontrolled hypertension. She was diagnosed 2 years ago and is currently taking hydrochlorothiazide, lisinopril, and amlodipine. She denies nonadherence and has a blood pressure of 170/100 mmHg which is equal in both arms. On routine laboratory examination, she has a potassium level of 2.9
mEq/L with a sodium level of 148 mEq/L. What is the most appropriate diagnostic test?

• Renal MRI/magnetic resonance angiography
• Morning renin and aldosterone concentrations
• Adrenal vein sampling
• 24-Hour urine cortisol concentration

9. A 56-year-old man with resistant hypertension begins to take a new antihypertensive agent. Within the next few weeks, he is diagnosed with pericarditis. Which of the following agents is most likely responsible?

• Carvedilol
• Minoxidil
• Amlodipine
• Captopril

10. A 36-year-old patient, status post heart transplantation, is found to have hypertension. He is currently taking prednisone, mycophenolate, and cyclosporine. Which of the following antihypertensive medications would increase cyclosporine levels?

• Lisinopril
• Hydrochlorothiazide
• Diltiazem
• Metoprolol