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Essential hypertension — MCCQE Part 1 MCQ

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EasyHypertensionEssential hypertensionMCCQE Part 1

A 52-year-old man has newly confirmed primary hypertension based on standardized office and home measurements. He has no symptoms or examination findings suggesting a specific secondary cause. According to the 2025 Hypertension Canada primary-care guideline, which investigation should be included routinely at the initial assessment?

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Correct answer: E — Urinalysis together with measurement of urinary albumin excretion

The 2025 Hypertension Canada appendix lists urinalysis and measurement of urinary albumin excretion among the routine tests suggested when hypertension is diagnosed. Albuminuria helps identify kidney damage and contributes to cardiovascular and renal risk assessment. Other routine components include sodium, potassium and creatinine, glycaemic testing, fasting lipids and a standard 12-lead ECG. Plasma metanephrines, renal-artery imaging and dexamethasone suppression are targeted investigations for patients with clinical features suggesting particular secondary causes; they are not universal screening tests. Echocardiography may be appropriate for a separate clinical indication, but it is not required before treatment in every uncomplicated newly diagnosed patient.

Reference: Hypertension Canada Primary Care Guideline, CMAJ 2025, https://www.cmaj.ca/content/197/20/E549; Hypertension Canada 2025 Appendix 1: Routine screening tests suggested upon hypertension diagnosis, https://hypertension.ca/wp-content/uploads/2025/05/2025-Primary-Care-Guideline-Routine-screening-test-and-Adaptation-process.pdf