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Primary hypertension — MCCQE Part 1 MCQ

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ModerateHypertensionPrimary hypertensionMCCQE Part 1

51-year-old man presents with repeated elevated clinic blood pressures. Home BP average is 147/92 mmHg and there is no end-organ damage. Which of the following is the most appropriate next step?

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Correct answer: B — Confirm cardiovascular risk and start lifestyle plus antihypertensive therapy according to Canadian thresholds

Confirm cardiovascular risk and start lifestyle plus antihypertensive therapy according to Canadian thresholds is best because sustained out-of-office hypertension requires risk-based treatment. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Out-of-office measurements reduce white-coat and masked-hypertension error.

Reference: Hypertension Canada 2025