AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 55-year-old male with newly diagnosed hypertension is started on lisinopril 10 mg daily. After one month, his blood pressure remains 145/92 mmHg. He reports no side effects. What is the most appropriate adjustment to his treatment plan?
- ARefer to cardiology for further evaluation.
- BAdd hydrochlorothiazide 12.5 mg daily.
- CIncrease lisinopril to 20 mg daily.
- DSwitch to amlodipine 5 mg daily.
Show answer & explanationAnswer & explanation
Correct answer: C. Increase lisinopril to 20 mg daily.
When a patient's blood pressure remains above target on an initial dose of a single antihypertensive medication and they are tolerating it well, the first step is typically to titrate that medication to its maximum effective dose before adding a second agent.
Why the other options are wrong
- A. Referral to cardiology is premature given that only one medication has been initiated and not yet fully optimized.
- B. While adding a diuretic is a valid next step, it's generally done after maximizing the first agent, especially if the patient is tolerating it.
- D. Switching to a different class is usually considered if the patient experiences intolerable side effects or if the initial agent is ineffective at its maximal dose.
Hypertension Monotherapy Titration
If blood pressure remains above target on the initial dose of a single antihypertensive medication, and the patient tolerates it well, the dose should be increased to the next step before considering adding a second agent.
- Titrate to maximum effective dose of first agent.
- Most agents have a recommended titration schedule.
- Consider combination therapy if monotherapy at maximal dose is insufficient.
Memory trick: First, maximize one, then add another, until the pressure is under cover.