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Hypertension — ABIM Board MCQ

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EasyCardiologyHypertensionABIM Board

A 54-year-old man with stage 2 hypertension (systolic/diastolic 152/94 mmHg) and 10-year ASCVD risk of 14% presents for initial management. He has no history of diabetes, chronic kidney disease, cardiovascular disease, or other compelling indications. What is the best initial pharmacotherapy strategy?

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Correct answer: C — Begin two first-line antihypertensive agents from different drug classes

For stage 2 hypertension (BP ≥140/90 mmHg), current 2025 AHA/ACC guidelines recommend initiating dual first-line antihypertensive therapy with agents from different drug classes (e.g., ACE inhibitor + thiazide diuretic, or CCB + thiazide), preferably as a single-pill combination to improve adherence and reduce time to blood pressure control. Lifestyle modification accompanies pharmacotherapy. This patient's 14% 10-year ASCVD risk reinforces the need for prompt treatment initiation. Option A delays therapy inappropriately; Option B reflects outdated sequential monotherapy practice; Option D reserves clonidine for resistant hypertension; Option E omits the second agent and beta-blockers are not first-line without specific indications.

Reference: Updates in the 2025 AHA/ACC Hypertension Guideline. Circulation. https://pmc.ncbi.nlm.nih.gov/articles/PMC12995957/