Paper I
2018 July (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

What should be the line of management of hypertension in this patient (2+2+2)

Q26 marksEssays

Answer

General approach to management of hypertension

  • Non-pharmacological (lifestyle) measures: Salt restriction, weight reduction, regular exercise, smoking/alcohol cessation, stress management — first-line for all patients, alongside or before drug therapy
  • Pharmacological therapy (choice tailored to the patient’s comorbidities):
    • Diuretics (e.g., Hydrochlorothiazide) — first-line, especially in elderly/uncomplicated hypertension
    • ACE inhibitors/ARBs — preferred in diabetics, chronic kidney disease, heart failure
    • Calcium channel blockers — preferred in elderly, isolated systolic hypertension
    • Beta blockers — preferred with coexisting ischaemic heart disease
    • Combination therapy is often required for adequate control, especially in stage 2 hypertension
  • Target: Gradual reduction of blood pressure to goal (typically <140/90 mmHg, or <130/80 in high-risk patients per current guidelines), avoiding precipitous drops
  • Regular follow-up and monitoring for adverse effects and treatment adherence

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