{"id":4200,"date":"2024-09-04T12:13:27","date_gmt":"2024-09-04T12:13:27","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4200"},"modified":"2025-10-01T11:38:22","modified_gmt":"2025-10-01T19:38:22","slug":"usmle-step-2-question-of-the-day-high-blood-pressure","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day: High blood pressure"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for your USMLE Step 2 with this case: A 55-year-old woman presents with stage 1 hypertension and occasional headaches. Her 24-hour blood pressure monitoring and low ASCVD risk score point to a critical next step in management.<\/em><\/strong><br><strong><em><br><\/em><\/strong><br>A 55-year-old woman presents to her primary care physician for a follow-up appointment for elevated blood pressure measurements. Two weeks ago, her blood pressure was 134\/81 mmHg. She reports occasional headaches and fatigue and denies chest pain, weight loss, or changes in bowel habits. She has no significant past medical history and does not take any medications. Her family history is notable for dyslipidemia in her father and hypertension in her mother. She has a 20-pack-year smoking history and exercises infrequently. Her BMI is 28 kg\/m2. Physical examination is unremarkable. Her 24-hour ambulatory blood pressure monitoring reveals a mean blood pressure of 136\/82 mmHg. Laboratory results are unremarkable. Her 10-year ASCVD risk is calculated at 6%. Which of the following is the most appropriate next step in the management of this patient\u2019s blood pressure?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;DASH diet and increased physical activity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Smoking cessation&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Renal ultrasound&nbsp;<br><\/strong><br><strong>D.&nbsp;ACE inhibitor therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Beta-blocker therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;DASH diet and increased physical activity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t B, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.\u00a0Smoking cessation\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>While smoking cessation is important for overall cardiovascular health, it does not directly lower blood pressure. The primary intervention for this patient should be lifestyle changes that directly influence blood pressure, including dietary modifications and increasing physical activity.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Renal ultrasound<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>&nbsp;A renal ultrasound may be considered when renal artery stenosis or renal parenchymal disease is suspected. This patient&#8217;s age, family history of hypertension, and absence of findings associated with kidney disease make a secondary cause of hypertension unlikely.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;ACE inhibitor therapy&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>ACE inhibitors are the first-line treatment option for the management of stage 1 hypertension in patients with a 10-year ASCVD risk of 10% or more. In this patient with a low ASCVD risk, management consists of lifestyle modifications with dietary modifications and increased physical activity.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Beta-blocker therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Beta-blockers are not first-line for the management of hypertension unless the patient has a specific indication, such as a history of heart failure with reduced ejection fraction, ischemic heart disease, or atrial fibrillation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient with a family history of hypertension and a sedentary lifestyle presents with occasional headaches and 24-hour ambulatory blood pressure measurements falling within the range of 130-139\/80-89 mmHg. Without findings suggestive of a secondary cause of hypertension, this presentation is consistent with&nbsp;stage 1 hypertension. Given that her 10-year ACVSD risk score is &lt;10%,&nbsp;lifestyle interventions including following a DASH diet and increasing her physical activity&nbsp;are the most appropriate next steps in management.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Blood pressure can be classified into:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normal blood pressure:&nbsp;systolic blood pressure (SBP) &lt;120 mm\/Hg and diastolic blood pressure (DPB) &lt;80 mmHg&nbsp;<\/li>\n\n\n\n<li>Elevated blood pressure: systolic blood pressure (SBP) between 120 and 129 mm\/Hg and diastolic blood pressure (DPB) &lt;80 mm\/Hg&nbsp;<\/li>\n\n\n\n<li>Stage 1 hypertension: SBP between 130 and 139 mm\/Hg or DBP between 80 to 89 mmHg&nbsp;<\/li>\n\n\n\n<li>Stage 2 hypertension: SBP \u2265140 mm\/hg, or DBP \u226590 mm\/hg&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The initial management of stage 1 hypertension depends on the patient&#8217;s 10-year risk of atherosclerotic cardiovascular disease (ASCVD). For patients with a&nbsp;10-year ASCVD risk less than 10%,&nbsp;lifestyle modifications are the primary intervention.&nbsp;This includes adopting a DASH (Dietary Approaches to Stop Hypertension) diet, reducing dietary sodium, enhancing potassium intake,&nbsp;increasing physical activity, and limiting alcohol intake. Smoking cessation is also recommended, but it does not directly influence blood pressure control. Patients with stage 1 hypertension and a&nbsp;10-year ASCVD risk of 10% or more, known cardiovascular disease, diabetes mellitus, or chronic kidney disease should be treated with&nbsp;antihypertensive medication and lifestyle modification.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"1009\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lifestyle-interventions-blood-pressure.png?w=1024\" alt=\"lifestyle interventions &amp; impact on blood pressure\" class=\"wp-image-4202\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lifestyle-interventions-blood-pressure.png 1246w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lifestyle-interventions-blood-pressure.png?resize=300,296 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lifestyle-interventions-blood-pressure.png?resize=768,757 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lifestyle-interventions-blood-pressure.png?resize=1024,1009 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with stage 1 hypertension and a low ASCVD risk (&lt;10%) should have their blood pressure managed with lifestyle modifications including adopting a DASH diet and increasing the amount of physical activity.&nbsp;Pharmacological interventions with anti-hypertensive agents are reserved for patients with a higher ASCVD risk (\u226510%) or for those with known cardiovascular disease, diabetes mellitus, or chronic kidney disease.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e136-e139] [published correction appears in Hypertension. 2018 Sep;72(3):e33]. Hypertension. 2018;71(6):1269-1324. doi:10.1161\/HYP.0000000000000066\u00a0<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/clinical-sciences\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more \u00a0USMLE\u00ae Step 2 CK practice questions?\u00a0Try Osmosis by Elsevier today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prepare for your USMLE Step 2 with this case: A 55-year-old woman presents with stage 1 hypertension and occasional headaches. Her 24-hour blood pressure monitoring and low ASCVD risk score point to a critical next step in management.A 55-year-old woman presents to her primary care physician for a follow-up appointment for elevated blood pressure measurements. [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":4201,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1370,45],"tags":[],"class_list":["post-4200","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-2-questions","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 Question of the Day: High blood pressure - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 Question of the Day: High blood pressure - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prepare for your USMLE Step 2 with this case: A 55-year-old woman presents with stage 1 hypertension and occasional headaches. Her 24-hour blood pressure monitoring and low ASCVD risk score point to a critical next step in management.A 55-year-old woman presents to her primary care physician for a follow-up appointment for elevated blood pressure measurements. 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