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Hypertension — CCFP MCQ

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HardChronic disease managementHypertensionCCFP

A 58-year-old man with type 2 diabetes attends for follow-up after three properly performed automated office blood pressure readings on separate visits averaging 136/84 mmHg. Home readings average 134/82 mmHg. His eGFR is 78 mL/min/1.73 m² and urine ACR is normal. He is ready to start medication. What is the most appropriate next step in management?

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Correct answer: C — Start a first-line antihypertensive and set a systolic target below 130 mmHg

The patient has confirmed hypertension by Canadian diagnostic criteria (averaged automated office readings ≥130/80 mmHg sustained across visits, supported by home readings). Canadian clinical practice guidelines recommend initiating therapy at this threshold in type 2 diabetes and targeting systolic BP <130 mmHg. First-line antihypertensives in diabetes include ACE inhibitors or ARBs, which provide cardioprotection and reduce albuminuria risk. Option A (secondary hypertension screening) is unwarranted without clinical clues. Option B (reassurance and deferral) contradicts guideline-directed therapy. Option D names beta-blockers as first-line, which is incorrect in diabetes due to adverse effects on glucose metabolism and lipid profiles. Option E inappropriately prioritizes diastolic targeting; systolic BP is the dominant predictor of cardiovascular risk in this age group and is the focus of modern guideline targets.

Reference: Hypertension Canada Guideline for the Diagnosis and Treatment of Hypertension in Adults in Primary Care, published in Canadian Family Physician, June 2025. https://www.cfp.ca/content/early/2025/06/13/cfp.20250616001