Categories
CDE Diabetes

Practice Exam: Treatment of Hypertension (Chapter 26)

Hypertension affects the majority of people with diabetes and acts as a potent multiplier for cardiovascular and microvascular complications. The 2018 Clinical Practice Guidelines provide aggressive targets and specific pharmacotherapy algorithms to reduce the risk of stroke, myocardial infarction, and renal failure.

This practice exam tests your ability to apply the evidence-based recommendations for blood pressure thresholds, treatment initiation, and the selection of antihypertensive agents based on comorbidities.

Key Concepts Covered in This Exam:

  • Therapeutic Targets: Mastering the recommended target of <130/80 mmHg for people with diabetes to maximize renal and cardiovascular protection.

  • First-Line Therapy: Identifying the specific indications (e.g., cardiovascular disease, chronic kidney disease, albuminuria) for choosing an ACE inhibitor or Angiotensin Receptor Blocker (ARB) as initial therapy.

  • Lifestyle Interventions: Applying non-pharmacologic strategies, including sodium restriction (<2000 mg/day), the DASH diet (high fruit/vegetable/low-fat dairy intake), and alcohol moderation.

  • Treatment Algorithms: Understanding when to start with standard-dose monotherapy versus when combination therapy may be required.

  • Renal Protection: Recognizing the unique role of renin-angiotensin-aldosterone system (RAAS) blockade in delaying the progression of diabetic nephropathy.

1. Case: A patient with type 2 diabetes is found to have a BP of 156/96 mmHg. When counseling about lifestyle modifications, what should you emphasize about the role of healthy behaviour interventions?

2. Case: A 65-year-old man with type 2 diabetes has established coronary artery disease and a BP of 145/90 mmHg. What class of antihypertensive should be recommended as initial therapy?

3. Case: A 52-year-old woman with type 2 diabetes and hypertension has normal urinary albumin excretion and no CVD. Her BP is 142/88 mmHg. Which of the following would be an appropriate first-line agent?

4. Case: A healthcare team is debating whether to change their BP target from <130/80 mmHg to <140/90 mmHg based on ACCORD BP findings. What is the most accurate interpretation of the current evidence?

5. According to Diabetes Canada, what is the target systolic blood pressure for people with diabetes?

6. Case: A patient with type 2 diabetes asks about the relationship between BP and cardiovascular risk. What should you explain?

7. Case: A 60-year-old woman with type 2 diabetes and CKD stage 3 has a BP of 150/94 mmHg. What is the recommended first-line antihypertensive therapy?

8. Case: A team is developing guidelines for elderly patients with diabetes and active CAD. What precaution does the chapter specifically mention for this population when initiating antihypertensive therapy?

9. Case: A patient with type 2 diabetes asks whether the benefits of BP lowering are greater in people with or without diabetes. Based on the evidence, what should you tell them?

10. What is the target diastolic blood pressure for people with diabetes according to Diabetes Canada?

11. Case: A 55-year-old man with type 2 diabetes, hypertension, and dyslipidemia (no CVD or albuminuria) asks which antihypertensive class has additional renal benefits beyond BP lowering. What should you tell him?

12. A patient asks about checking their blood pressure at home. According to the guidelines, what should you tell them?

13. According to the guidelines, how often should people with diabetes have their blood pressure checked at minimum?

14. Case: A patient with type 2 diabetes asks whether there is good evidence for the systolic BP target of <130 mmHg. What is the most accurate response based on the guideline evidence?

15. Case: A 62-year-old man with type 2 diabetes has additional CV risk factors including dyslipidemia and family history of premature CVD. His urinary albumin excretion is normal. What is the recommended first-line antihypertensive?

16. How many servings of fruits and vegetables per day are recommended as part of healthy behaviour interventions for hypertension?

17. A diabetes educator is reviewing the evidence about stroke prevention with BP lowering. According to multiple meta-analyses cited in the guidelines, what additional protection does lowering BP <130 mmHg confer?

18. Case: A clinician is considering whether to use early combination therapy. According to the guidelines, in what clinical context has early combination therapy historically been encouraged?

19. Case: A 58-year-old man with type 2 diabetes has a BP of 148/92 mmHg. He has no known CVD but has microalbuminuria. What is the most appropriate first-line antihypertensive agent?

20. How many servings of low-fat dairy products per day are recommended as part of healthy behaviour interventions?

21. Case: A 70-year-old woman with type 2 diabetes and autonomic neuropathy is being started on antihypertensive therapy. What precaution should be considered?

22. Case: A clinician asks why intensive BP lowering might be particularly important in people with diabetes. According to the guidelines, what is the most evidence-based response?

23. What is the maximum recommended alcohol consumption for men with diabetes and hypertension?

24. According to the guidelines, what is the recommended daily sodium intake target for people with diabetes and hypertension?