Best treatment for hypertension? | Last Rationale of the Week for 2020

This is our last post of 2020! We want to thank all of you for your support and participation in our Question and Rationale of the Week! We will see you in 2021 with more exciting questions and rationales. Can’t wait!

Our December 22nd Question asked how to best treat a blood pressure of 162/94 according to ADA Standards of Care. Less than half of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is 63, has diabetes, and has a B/P of 162/94 which is repeated on a separate visit.  JR also has albuminuria. What would be the recommended pharmacological approach based on the ADA Standards of Care?

Answer Choices:

  • Start on DASH Diet plus one blood pressure medication.
  • Start ACEi plus ARB.
  • Start ACEi or ARB plus another blood pressure medication.
  • Avoid diuretics if on an ACEi or ARB.

As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. Being familiar with the ADA Standards of Care is critical to pass either the CDCES or BC-ADM exam. The section of CV risk management is especially important, since the leading cause of death in diabetes is heart disease.

Answer 1 is incorrect. 25.11% chose this answer. “Start on DASH Diet plus one blood pressure medication.” Starting this person on the DASH meal plan along with a BP medication are both correct, however, given the extreme hypertension, more action is required.

Answer 2 is incorrect. 16.78% of you chose this answer. “Start ACEi plus ARB.” According to the ADA Standards, it is not recommended to use both of these agents together. The standards recommend to use EITHER an ACEi or ARB plus another blood pressure agent (diuretic, Calcium Channel Blocker, etc) to treat hypertension (see image below).

Answer 3 is correct, 48.52% of you chose this answer “Start ACEi or ARB plus another blood pressure medication.” According to ADA Standards (see image below), a confirmed BP where either the systolic is 160 or greater and the diastolic is 100 or greater, requires the initiation of 2 anti-hypertensive medications. Of course, we would request home blood pressure monitoring, review symptoms of orthostatic hypotension, and encourage lifestyle interventions.

Diabetes specialists have a tremendous opportunity to reduce CV events by being familiar with the standards and advocating on behalf of our clients for needed interventions.

Answer 4 is incorrect, 9.59% of you chose this answer. “Avoid diuretics if on an ACEi or ARB.” ADA standards include adding a diuretic to an ACEi or ARB if blood pressure is not at target (see image below).

From ADA Standards 2021 – Section 10, CV Disease

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

  • January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
  • January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
  • January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
  • January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
  • January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
  • January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.

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