Question 1

What is the target blood pressure for adults with hypertension?

Accepted Answer

For most adults under 65, the target is <130/80 mmHg (ACC/AHA) or <140/90 mmHg (ESH 2023/NICE). For adults aged 65–79, a target of <140/90 mmHg is appropriate. Patients over 80 can be treated to <150/90 mmHg. Targets should be individualised based on comorbidities, frailty, and tolerability.

Question 2

Which antihypertensive drug should be started first in hypertension?

Accepted Answer

First-line choices are ACE inhibitors (or ARBs), calcium channel blockers (CCBs), or thiazide-like diuretics (indapamide/chlortalidone). ACE inhibitors/ARBs are preferred in diabetes, CKD, or proteinuria. CCBs are preferred in older or Afro-Caribbean patients. Dual therapy is recommended from the outset for BP >160/100 mmHg. Beta-blockers are reserved for specific indications such as heart failure, angina, or post-MI.

Question 3

What is the difference between hypertensive urgency and hypertensive emergency?

Accepted Answer

Hypertensive urgency is severe hypertension (typically BP >180/120 mmHg) without acute end-organ damage. It can be managed with oral antihypertensives and close outpatient follow-up. Hypertensive emergency (crisis) involves the same BP level but WITH acute end-organ damage — hypertensive encephalopathy, acute MI, aortic dissection, pulmonary oedema, or acute kidney injury. Hypertensive emergency requires hospital admission and IV antihypertensives (e.g., labetalol, nitroprusside).

Question 4

When should a hypertensive patient be referred to a specialist?

Accepted Answer

Referral to a specialist is indicated for: suspected secondary hypertension (young age, resistant HTN, sudden onset, hypokalaemia); resistant hypertension (BP uncontrolled on 3+ drugs including a diuretic at optimal doses); hypertensive emergency or end-organ damage requiring investigation; pregnancy-related hypertension; and hypertension in children or adolescents.

Question 5

How much does lifestyle modification reduce blood pressure?

Accepted Answer

Lifestyle changes can reduce systolic BP meaningfully: DASH diet (–8 to –14 mmHg), sodium restriction to <2g/day (–2 to –8 mmHg), regular aerobic exercise 30 min/day (–4 to –9 mmHg), weight loss per 10 kg (–5 to –20 mmHg), limiting alcohol to <2 units/day (–2 to –4 mmHg), and smoking cessation. Combined, these changes can reduce BP by 15–20 mmHg and may allow medication dose reduction.

Question 6

How often should blood pressure be monitored after starting treatment?

Accepted Answer

After initiating or changing antihypertensive therapy, blood pressure should be reassessed within 4 weeks. Once stable on target, review every 3–6 months. ABPM (ambulatory BP monitoring) or HBPM (home monitoring) is preferred to confirm diagnosis and guide titration. Annual review should include renal function, electrolytes, and cardiovascular risk reassessment.

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