PEBC MCQ Hypertension & Dyslipidemia question: year old male newly diagnosed with hypertension after home monitoring averaged

PEBC MCQHypertension & Dyslipidemia

PK is a 52 year old male newly diagnosed with hypertension after home monitoring averaged 148/94 mm Hg. He has no other medical conditions and takes no medications. According to Hypertension Canada's 2025 primary care guideline, which initial treatment is most appropriate?

a. A low-dose single-pill combination of an ARB and a thiazide diuretic
b. Metoprolol monotherapy, increased every 2 weeks to reach target
c. Lifestyle changes alone for 6 months before any drug therapy
d. A combination of an ACE inhibitor and an ARB to block the pathway fully

Show the answer and explanation

Answer: a. A low-dose single-pill combination of an ARB and a thiazide diuretic

Hypertension Canada's 2025 guideline recommends starting drug therapy at BP 140/90 mm Hg or higher and using low-dose combination therapy, ideally a single-pill combination, from two of three classes: ACEI or ARB, thiazide or thiazide-like diuretic, and long-acting dihydropyridine CCB. Beta-blockers are not first line without a specific indication, and an ACEI plus ARB increases hyperkalemia and kidney injury with no added benefit. Source: Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care (Goupil R et al. CMAJ 2025;197:E549), recommendations on pharmacotherapy initiation and initial combination therapy.

Common mistake

Starting with monotherapy, or with a beta-blocker, out of habit from older guidance.

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