ABIM & Internal Medicine Shelf Exam Review Question of the Week: Blood Pressure Goals in Hypertension
Concepts related to cardiology are seen on the ABIM and Med School Clerkship Shelf exams more frequently than any other specialty area. On the former, according to the ABIM exam blueprint, cardiovascular disease is found in 14% of questions while it comprises 15-20% of questions on the NBME shelf exam. Below, we present a sample cardiology-related question from the Knowmedge Internal Medicine QVault, related to hypertension management:
55-year-old female with diabetes mellitus reports to her PCP’s office for a routine check-up. She denies any complaints at this time. Hemoglobin A1c was 6.9% on labwork done last week. Her urine studies reveal proteinuria. She does not have any personal or family history of coronary artery disease. She is currently taking lisinopril 5mg daily. Her vital signs include blood pressure 142/82mmHg, pulse 80/min. Physical examination shows no significant abnormalities. What is this patient’s goal blood pressure?
A. 120/80mmHg B. 125/75mmHg C. 130/80mmHg D. 140/80mmHg
The essential primary care topic of blood pressure management has been changing rapidly in recent years. With the release of 6th edition of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 6) in 1997, the goal blood pressure was 140/90mmHg in patients without diabetes or renal/other end organ damage. Diabetics were recommended to have a goal blood pressure of 130/85mmHg. For those with renal insufficiency and proteinuria the goal was 125/75mmHg.
JNC 7 changed these values in 2003: While 140/90mmHg remained the general target, 130/80mmHg became the stricter goal for diabetics with or without proteinuria.
In late 2012, the American Diabetes Association changed its guidelines to support a target systolic blood pressure in diabetics identical to that of the general population: 140mmHg. Diastolic goal remains at 80mmHg. This makes Choice D (140/80mmHg) the correct answer.
The long-awaited JNC 8 is expected out later in 2013.
Fortunately, for board purposes, we don’t need to recall previous guidelines, just the most recent one. For now, that is 140/80mmHg in diabetics.
You can view all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.