Hypertension — EECC MCQ

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EasyHypertension & Preventive CardiologyHypertensionEECC

A 52-year-old man is diagnosed with hypertension (confirmed office BP 158/96 mmHg, ambulatory daytime mean 152/94 mmHg). He has no diabetes, CKD, or established cardiovascular disease. His SCORE2 10-year risk is 8%. Per the 2024 ESC Hypertension Guidelines, what is the recommended initial pharmacological strategy?

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Correct answer: B — Low-dose two-drug combination, preferably as a single-pill combination

This patient has confirmed hypertension by ESC criteria (office BP ≥140/90 mmHg, supported by ambulatory daytime mean above the hypertension threshold). Under the 2024 ESC hypertension guideline, adults with confirmed hypertension should generally start pharmacological treatment with an upfront low-dose two-drug combination, preferably as a fixed-dose single-pill combination. Usual first-line combinations are a renin–angiotensin system blocker (ACE inhibitor or ARB) plus either a dihydropyridine calcium-channel blocker or a thiazide/thiazide-like diuretic. Triple therapy is the next step if BP remains uncontrolled, not the initial strategy here. Monotherapy is reserved for selected groups such as very old, frail, orthostatic, or lower-BP elevated-risk patients; lifestyle advice is important but should not be used alone for this confirmed hypertension presentation. Therefore the recommended initial pharmacological strategy is low-dose two-drug combination therapy, preferably as a single-pill combination.

Reference: 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal 2024;45(38):3912–4018. https://academic.oup.com/eurheartj/article/45/38/3912/7741010