Hypertension: Clinical

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Hypertension: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 55-year-old woman comes to the clinic for a hypertension follow up. She was diagnosed with hypertension 6 months ago and was prescribed a low-sodium diet and exercise. Medical history is significant for diabetes mellitus type 2 that is currently managed with metformin. She has been smoking 1 pack of cigarettes daily for 20 years. Family history is significant for osteoporosis in her mother and diabetes mellitus in her father. Temperature is 37.0 °C (98.6 °F), pulse is 80/min, and blood pressure is 152/95 mmHg. Urinalysis reveals microalbuminuria. DXA scan shows normal bone mineral density. A decision is made to add a pharmacological treatment to manage the hypertension. The first-line treatment for this patient’s condition works by which of the following mechanisms of action?


Content Reviewers

Hypertension, or high blood pressure, affects over a billion people around the world.

Now, ‘normal’ systolic blood pressure is defined as less than 120 mmHg, and normal diastolic pressure is less than 80 mmHg.

Elevated blood pressure is when systolic blood pressure is between 120 and 129 mmHg and less than 80 mmHg on the diastolic side.

Stage 1 hypertension is between 130 and 139 mmHg on the systolic side, and between 80 and 89 mmHg on the diastolic side.

Stage 2 hypertension is defined as anything that is 140 mmHg or higher on the Systolic side and 90 mmHg or higher on the diastolic side.

Typically, both systolic and diastolic pressures tend to rise or fall together, but that’s not always the case.

Sometimes, you can have systolic or diastolic hypertension, when one number is normal and the other is really high. This is referred to as isolated systolic hypertension or isolated diastolic hypertension.

There are two main types of blood pressure measurements - office blood pressure, which is taken in a clinic, emergency department, or hospital, and an out-of-office blood pressure.

The out-of-office blood pressure is either a home blood pressure, which is taken by the patient at home, or an ambulatory blood pressure monitoring or ABPM, which involves 24-hour monitoring of blood pressure as the patients live their normal daily life, and while they sleep, to see if the blood pressure falls at night compared to during the day. It uses a small digital blood pressure machine that is attached to a belt around the body and it’s connected to a cuff around the upper arm.


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