PEBC Part I (MCQ) · Competency 1A Clinical Care (about 50% of Part I)

Hypertension & Dyslipidemia

Hypertension and lipid management are core Part I clinical topics: expect patient scenarios asking for the next drug, a target, a monitoring step or an interaction, using Hypertension Canada's 2025 primary care guideline and the 2021 CCS dyslipidemia guidelines.

1A Clinical Care3 min read7 sections

Checked against the Hypertension Canada primary care guideline (CMAJ 2025;197:E549); 2021 CCS Guidelines for the Management of Dyslipidemia (Can J Cardiol 2021;37:1129); Health Canada product monographs; checked 12-13 Oct 2026. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC).

Must-know for the exam

Hypertension is BP 130/80 mm Hg or higher measured optimally; confirm with home or ambulatory readings (Hypertension Canada 2025).
Start drugs at 140/90 or higher, or at systolic 130-139 with high CV risk (CVD, diabetes, CKD, Framingham 20% or more, age 75+).
Target systolic BP below 130 mm Hg if tolerated; relax it for frailty, falls or orthostatic hypotension.
Start with a low-dose single-pill combination of two of: ACEI or ARB, thiazide/thiazide-like diuretic, long-acting dihydropyridine CCB.
Never combine an ACEI with an ARB; add spironolactone only after three classes at maximal doses, checking potassium in 2-4 weeks.
ACEIs and ARBs are fetotoxic: switch before conception and counsel anyone who could become pregnant.
CCS 2021: statin-indicated conditions include ASCVD, most diabetes and CKD, AAA and LDL-C 5.0 mmol/L or higher.
In ASCVD on a maximal statin, intensify when LDL-C is 1.8 or higher (non-HDL-C 2.4, apoB 0.7): add ezetimibe and/or a PCSK9 inhibitor.
Measure Lp(a) once in a lifetime; non-fasting lipids are acceptable for most people.
Avoid simvastatin with strong CYP3A4 inhibitors (clarithromycin) and avoid gemfibrozil with statins.

On this page · 7 sections

Traps that cost marks

Starting with monotherapy, or with a beta-blocker, out of habit from older guidance.
Quoting older targets (below 140/90) or the SPRINT target of below 120.
Diagnosing hypertension from an office reading when out-of-office readings are normal.
Treating any risk factor as 'high risk' rather than using the listed conditions.
Jumping to spironolactone before the three complementary classes are used.
Relying on symptoms to detect hyperkalemia.
Believing ACE inhibitor harm is limited to the first trimester.
Stopping a renoprotective ACE inhibitor for an expected small creatinine rise.

How this is tested on Part I

Most items are applied: a patient profile with BP readings or lipids, and a question about what to start, change or monitor. Some ask about ACEI cough or angioedema, thiazide hyponatremia, CCB edema or NSAID interactions.

Hypertension: diagnosis and first steps

Measure with a validated device: seated, back supported, arm at heart level, 3 readings 1 minute apart.

Home monitoring for diagnosis: duplicate readings twice daily for a week.

White coat hypertension: high in the office, normal at home; masked hypertension is the reverse.

Lifestyle for everyone: sodium below 2 g/day, less alcohol, activity, potassium-rich diet if safe.

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Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.