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Cardiovascular

Which of the following hypertension medications should not be used in pregnant women?

A. Calcium channel blockers

B. Thiazide diuretics

C. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors

D. Beta blockers

Answer: C

Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are designated as pregnancy category “X” and may cause congenital abnormalities, especially in the second and third trimester.

Calcium channel blockers such as nifedipine and beta blockers such as labetalol are preferred for the treatment of hypertension in pregnant women. Diuretics, such as thiazide diuretics, may be used with caution in pregnant women but may increase the risk of maternal volume loss.

Reference: Marrs JC, Thompson AM. Antihypertensive Therapy in Females: A Clinical Review Across the Lifespan. Pharmacotherapy. 2016;36(6):638-651. Pubmed ID: 27072935.

A 52-year-old man presents to your office for a health maintenance exam, and initial vital signs show a blood pressure of 154/94 mm Hg. Previous blood pressure measurements were normal. What is the next step in management?

A. Start an antihypertensive medication

B. Repeat the blood pressure measurement

C. Look for causes of secondary hypertension

D. Perform a urine drug screen

Answer: B

If the initial blood pressure measurement is elevated, it should be repeated. The diagnosis of hypertension is based on the average of two or more properly measured blood pressure values over two or more visits. It would be incorrect to start an antihypertensive medication after the first measurement of an elevated blood pressure. While it is important to consider secondary causes of hypertension, the diagnosis of hypertension must first be made by repeating the blood pressure measurement and recording multiple instances of elevated blood pressure. While a urine drug screen may be helpful in the search for substances that may cause elevated blood pressure (such as cocaine and methamphetamine), the elevated blood pressure measurement should first be repeated before any other workup is undertaken.

References: Reeves RA. The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. JAMA. 1995;273(15):1211-1218. Pubmed ID: 7707630.

Onusko E. Diagnosing secondary hypertension. Am Fam Physician. 2003;67(1):67-74. Pubmed ID: 12537168.

Which of the following statements is correct regarding blood pressure evaluation?

A. The patient should be lying quietly on the exam table for 5 minutes ...

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