American Board of Internal Medicine (ABIM) Certification Practice Exam

What ASCVD risk percentage is recommended to initiate pharmacological management in stage one hypertension?

1. 5%

2. 7%

3. 10%

4. 15%

The correct answer is: 10%

Pharmacological management for stage one hypertension is recommended when a patient has an atherosclerotic cardiovascular disease (ASCVD) risk percentage of 10% or higher over the next 10 years. This threshold is based on guidelines which suggest that while lifestyle modifications should always be the first step in managing hypertension, starting medication is essential when the ASCVD risk reaches this level. At this risk percentage, the potential benefits of pharmacotherapy in preventing cardiovascular events outweigh the risks associated with medication initiation. This approach is consistent with the aim of preventing the progression of hypertension and its complications, especially in individuals who may have other risk factors such as age, diabetes, or existing cardiovascular conditions. Lower ASCVD risk percentages, such as 5% or 7%, typically indicate that the patient may be able to manage their hypertension effectively through lifestyle changes alone, without the immediate need for medication. Therefore, treatment guidelines focus on the 10% risk as a crucial point for implementing pharmacological intervention.