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1. A 68-year-old Black woman has hypertension and stable ischemic heart disease. She is treated with chlorthalidone 25 mg po daily and lisinopril 40 mg po daily. Her blood pressure is 134/86 mm Hg and 136/88 mm Hg when repeated. Her heart rate is 80 beats/minute and all other serum chemistry values are normal. Which of the following is the most appropriate recommendation for her antihypertensive regimen?

A. Continue her current regimen unchanged B. Add amlodipine C. Add metoprolol succinate D. Change chlorthalidone to hydrochlorothiazide 25 mg po daily E. Unsure

2. A 60-year-old woman with hypertension and type 2 diabetes is treated with ramipril 10 mg po daily, amlodipine 10 mg po daily, and hydrochlorothiazide 12.5 mg po daily. She takes all these medications in the morning upon awakening. Her blood pressure is at goal on this regimen, and it has been for several years. The patient was told by her son that she should take her antihypertensive medications at bedtime to receive the maximum benefit. Which of the following is the most appropriate recommendation for the administration of this patient's antihypertensive medications?

A. Switch all 3 medications to be taken at bedtime B. Take ramipril and amlodipine at bedtime and hydrochlorothiazide in the morning C. Take amlodipine at night and ramipril and hydrochlorothiazide in the morning D. Continue taking all 3 medications in the morning E. Unsure

3. A 50-year-old patient is diagnosed with hypertension when their BP is 150/90 mm Hg (148/88 mm Hg when repeated). They do not have compelling indications and amlodipine 5 mg po daily is started. Four weeks later, BP is 136/82 mm Hg (134/80 mm Hg when repeated) and amlodipine is increased to 10 mg po daily. Four weeks later, BP is 124/76 mm Hg (126/78 mm Hg when repeated), but the patient is now complaining of bothersome leg edema bilaterally. Which of the following is the most appropriate recommendation for this patient?

A. Decrease amlodipine to 5 mg po daily and add lisinopril 10 mg po daily B. Stop amlodipine and start hydrochlorothiazide 25 mg po daily C. Add furosemide 10 mg po daily D. Continue amlodipine 10 mg po daily and have the patient reduce their sodium intake E. Unsure

4. A 69-year-old white woman has type 2 diabetes mellitus and hypertension. She also smokes. Her baseline fasting lipid panel was total cholesterol 238 mg/dL, HDL-C 41 mg/dL, LDL-C 152 mg/dL, and triglycerides 225 mg/dL. Her blood pressure was 140/80 mm Hg on losartan 50 mg po daily. Rosuvastatin 20 mg orally daily is started and 12-week later her fasting lipid panel is: total cholesterol 164 mg/dL, HDL-cholesterol 44 mg/dL, LDL-cholesterol 85 mg/dL, and TG 175 mg/dL. Which of the following is most appropriate for this patient at this time based?

A. Continue current therapy B. Increase rosuvastatin to 40 mg daily C. Change rosuvastatin 20 mg daily to atorvastatin 10 mg daily D. Add evolocumab E. Unsure

5. A 64-year-old man with hypertension and clinical ASCVD is treated with atorvastatin 80 mg po daily and ezetimibe 10 mg po daily. His baseline LDL-C was 160 mg/dL before medication. On this regimen, his fasting lipid panel is total cholesterol 150 mg/dL, HDL-C 37 mg/dL, LDL-C 63 mg/dL, and triglycerides 250 mg/dL. Which of the following additions to his regimen is the most likely to reduce his risk of a CV event?

A. Icosapent ethyl B. Bempedoic acid C. Alirocumab D. Gemfibrozil E. Unsure

6. Which of the following tests is recommended to further inform the decision on whether to start statin therapy in a primary prevention patient with a 10-year ASCVD risk of 9% and no risk-enhancing factors?

A. Coronary artery calcium B. Electrocardiogram C. Echocardiogram D. Serum homocysteine E. Unsure

7. Which of the following medications lowers LDL-C by selectively blocking the production of PCSK9?

A. Bempedoic acid B. Evolocumab C. Inclisiran D. Icosapent ethyl E. Unsure

8. A 72-year-old man with a history of myocardial infarction 2 years ago and peripheral arterial disease had a peripheral revascularization procedure last week and is now stable. The patient is not at high risk for major bleeding. Which of the following antithrombotic regimens is most appropriate for him?

A. Aspirin 81 mg po daily B. Clopidogrel 75 mg po daily C. Warfarin dosed to achieve an INR of 2-3 with aspirin 81 mg po daily D. Rivaroxaban 2.5 mg po twice daily with aspirin 81 mg po daily E. Unsure

9. A 73-year-old man has a history of hypertension, hypercholesterolemia, and recurrent venous thromboembolism. His 10-year ASCVD risk score is 20%. Current medications are lisinopril 10 mg po daily, bisoprolol 10 mg po daily, atorvastatin 80 mg po daily, aspirin 81 mg po daily, and apixaban 5 mg po twice daily. Which of the following is the most appropriate recommendation for this patient?

A. Stop apixaban B. Stop aspirin C. Add omeprazole D. Increase aspirin to 325 mg po daily E. Unsure