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Hypertension in 2014: Making sense of the guidelines

doi: 10.1097/01.NPR.0000450820.67133.81
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Hypertension in 2014: Making sense of the guidelines

GENERAL PURPOSE: To review current hypertension guidelines. Learning Objectives: After reading the article and taking this test, you should be able to: 1. Identify the key differences between the 2013 ASH/ISH and JNC 8 hypertension publications. 2. Discuss hypertension management guidelines.

  1. In 2013, all of the following organizations published hypertension documentsexceptthe
    1. JNC.
    2. ASH and ISH.
    3. AHA, ACC, and CDC.
    4. NHLBI.
  2. The JNC 8 guidelines are based on
    1. expert opinion.
    2. AHA protocols.
    3. randomized clinical trials.
    4. longitudinal studies.
  3. JNC 8 researchers sought to answer whether health outcomes were improved by allexcept
    1. treating to specific BP goal.
    2. initiating therapy at specific BP thresholds.
    3. treating with specific medications.
    4. combining lifestyle changes with pharmacotherapy.
  4. A JNC 8 recommendation based on expert opinion or conflicting evidence is considered
    1. Grade A.
    2. Grade D.
    3. Grade E.
    4. ungraded.
  5. Initiating pharmacologic treatment in the general population 60 years and older at a SBP of 150 mm Hg or higher or DBP of 90 mm Hg or higher was recommended at Grade
    1. A.
    2. B.
    3. C.
    4. E.
  6. For people under age 60, JNC 8 guidelines focus on
    1. SBP.
    2. DBP.
    3. weight control.
    4. comorbidities.
  7. What do JNC 8 guidelines recommend for initial pharmacologic therapy in the general Black population?
    1. ACEIs
    2. ARBs
    3. beta-blockers
    4. thiazide-type diuretics or CCBs
  8. Initial or add-on therapy including ACEIs or ARBs is recommended by JNC 8 for
    1. all patients with diabetes.
    2. all patients with CKD.
    3. patients with kidney disease and diabetes.
    4. Black patients with kidney disease.
  9. Which condition is addressed in the ASH/ISH guidelines but not in JNC 8?
    1. diabetes
    2. stroke
    3. CVD
    4. resistant hypertension
  10. How do ASH/ISH guidelines define hypertension in adults over 80 years of age?
    1. BP of 140/90 mm Hg or higher
    2. DPB greater than 80 mm Hg
    3. SBP greater than 150 mm Hg
    4. SBP greater than 140 mm Hg
  11. What intervention is recommended by ASH/ISH guidelines for a patient with DBP between 80 and 89 mm Hg?
    1. none
    2. counseling about lifestyle modification
    3. pharmacotherapy
    4. assessment for comorbidities
  12. ASH/ISH guidelines classify SBP of 160 mm Hg or higher or DBP of 100 mm Hg or higher as
    1. prehypertension.
    2. Stage I hypertension.
    3. Stage II hypertension.
    4. Stage III hypertension.
  13. ACEIs or ARBs are recommended by ASH/ISH as Stage I initial therapy in
    1. non-Black patients less than 60 years.
    2. Black patients less than 60 years.
    3. non-Black patients over 60 years.
    4. Black patients over 60 years.
  14. For patients with resistant hypertension, ASH/ISH recommends adding
    1. hydrochlorothiazide.
    2. spironolactone.
    3. CCBs.
    4. peripheral adrenergic inhibitors.
  15. What drug treatment does JNC 8 recommend for Black patients with diabetes mellitus?
    1. ACEI
    2. ARB
    3. CCB
    4. potassium sparing diuretics
  16. The AHA/ACC/CDC Science Advisory discusses the importance of developing and disseminating
    1. published expert opinion.
    2. electronic medical records.
    3. accreditation standards.
    4. evidence-based algorithms.
  17. Which of the following isnota key AHA/ACC/CDC Advisory principle for creating hypertension algorithms?
    1. An appropriate patient version should be included.
    2. The algorithm should be stable, not requiring periodic updating.
    3. The cost of monitoring and treatment should be considered.
    4. The format should be compatible with electronic health records.
  18. AHA/ACC/CDC advises developers that algorithms shouldnotbe used to
    1. overtreat a vulnerable population.
    2. make specific treatment recommendations.
    3. discourage nonpharmacologic interventions.
    4. counter the healthcare provider's clinical judgment.
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