CHS Hypertension in Special Populations 1 — Questions and Answers
Question 1: Which antihypertensive medication is contraindicated during pregnancy?
- Labetalol
- Methyldopa
- ACE inhibitors (Correct answer)
- Hydralazine
Correct answer: ACE inhibitors
ACE inhibitors are absolutely contraindicated during pregnancy, especially in the second and third trimesters. Their use can cause severe fetal renal abnormalities, oligohydramnios, growth restriction, and even fetal death, making them unsafe for pregnant patients.
Question 2: What is the first-line treatment for hypertension in African American patients without CKD?
- ACE inhibitors
- Beta-blockers
- Thiazide diuretics or calcium channel blockers (Correct answer)
- Aldosterone antagonists
Correct answer: Thiazide diuretics or calcium channel blockers
Current guidelines recommend thiazide diuretics or calcium channel blockers as first-line treatment for hypertension in African American adults without chronic kidney disease. This recommendation is based on evidence showing these classes are generally more effective in this population compared to ACE inhibitors or ARBs for initial therapy.
Question 3: Which condition defines hypertension in children?
- BP > 120/80 mmHg
- BP > 140/90 mmHg
- BP ≥ 95th percentile for age, sex, and height (Correct answer)
- BP ≥ 90th percentile for weight
Correct answer: BP ≥ 95th percentile for age, sex, and height
In children, hypertension is defined by blood pressure readings that are consistently at or above the 95th percentile for their age, sex, and height. This percentile-based approach accounts for the significant variations in normal blood pressure across different developmental stages in pediatric populations.
Question 4: Which hypertensive disorder is specific to pregnancy?
- Essential hypertension
- Secondary hypertension
- Preeclampsia (Correct answer)
- White-coat hypertension
Correct answer: Preeclampsia
Preeclampsia is a serious hypertensive disorder that is unique to pregnancy, typically developing after 20 weeks of gestation. It is characterized by new-onset hypertension accompanied by proteinuria or other signs of end-organ dysfunction, posing significant risks to both mother and fetus.
Question 5: In elderly patients, which antihypertensive class is commonly associated with orthostatic hypotension?
- Thiazide diuretics
- Calcium channel blockers
- Alpha-blockers (Correct answer)
- Beta-blockers
Correct answer: Alpha-blockers
Alpha-blockers work by relaxing blood vessels, which can lead to a significant drop in blood pressure upon standing, known as orthostatic hypotension. This effect is particularly pronounced in elderly patients due to age-related changes in baroreflex sensitivity and vascular compliance, increasing their risk of falls.
Question 6: What is a key consideration when managing hypertension in patients with diabetes?
- Avoid all medications affecting the kidneys
- Use beta-blockers first-line
- Prefer ACE inhibitors or ARBs (Correct answer)
- Target BP < 150/90 mmHg
Correct answer: Prefer ACE inhibitors or ARBs
In patients with diabetes, ACE inhibitors or ARBs are preferred antihypertensive agents due to their renoprotective effects, particularly in preventing or slowing the progression of diabetic nephropathy. These medications help reduce proteinuria and preserve kidney function, offering benefits beyond just blood pressure control.
CHS Hypertension in Special Populations 1
Which antihypertensive medication is contraindicated during pregnancy?