A 55-year-old man presents to your clinic for a routine check-up. He feels well and has no specific complaints. His past medical history is unremarkable. His blood pressure during the visit is measured at 160/95 mmHg. On repeat measurement after five minutes, the blood pressure remains elevated at 158/94 mmHg. He has no known family history of cardiovascular disease, diabetes, or stroke. He does not smoke and consumes alcohol occasionally. His body mass index (BMI) is 29. Investigations: Blood tests show normal renal function and electrolyte levels. Fasting blood glucose: 90 mg/dL Lipid profile: LDL 130 mg/dL, HDL 45 mg/dL, triglycerides 150 mg/dL MCQs: What is the next best step in managing this patient? A) Initiate lifestyle modifications only B) Start an antihypertensive medication immediately C) Order ambulatory blood pressure monitoring (ABPM) D) Repeat blood pressure measurements in 6 months Which of the following is an appropriate first-line antihypertensive for this patient? A) Thiazide diuretic B) Beta-blocker C) Alpha-blocker D) ACE inhibitor What is the target blood pressure for this patient according to current guidelines? A) Less than 140/90 mmHg B) Less than 130/80 mmHg C) Less than 120/80 mmHg D) Less than 150/90 mmHg Answers with Explanations: Answer: C) Order ambulatory blood pressure monitoring (ABPM) Explanation: Ambulatory or home blood pressure monitoring is recommended to confirm the diagnosis of hypertension, especially for newly diagnosed patients without symptoms. It helps rule out white-coat hypertension, where blood pressure is elevated in the clinical setting but normal otherwise. Answer: A) Thiazide diuretic Explanation: Thiazide diuretics are commonly recommended as first-line agents for managing hypertension, particularly in uncomplicated cases without comorbid conditions like heart failure or chronic kidney disease. ACE inhibitors or calcium channel blockers are also first-line options depending on the patient’s comorbidities. Answer: B) Less than 130/80 mmHg Explanation: Current guidelines recommend a target blood pressure of less than 130/80 mmHg for most adults with hypertension, especially those at risk for cardiovascular disease. Overview of the Topic: Hypertension Hypertension is a common condition that significantly increases the risk of cardiovascular events, including heart attacks and strokes. Primary (essential) hypertension is the most frequent form, and it is usually managed with lifestyle modifications (diet, exercise, weight loss) and pharmacological therapy (thiazides, ACE inhibitors, ARBs, calcium channel blockers). Early diagnosis and effective treatment can prevent complications such as hypertensive heart disease, renal failure, and stroke. Key learning points: Accurate diagnosis through confirmatory blood pressure monitoring is crucial. First-line treatments include lifestyle modifications and medications based on comorbidities. The target blood pressure for most patients is less than 130/80 mmHg.
