Hypertension MCQs With Answer

Introduction: Hypertension MCQs With Answer is a focused study resource for B. Pharm students preparing for pharmacology and therapeutics exams. This concise, keyword-rich introduction covers essential concepts such as blood pressure regulation, classification of hypertension, pharmacological classes (ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics), mechanisms of action, adverse effects, drug interactions, monitoring, and management of special situations like pregnancy and hypertensive emergencies. Each question emphasizes clinical relevance, drug mechanisms, and pharmaceutical considerations to deepen your understanding and aid revision. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which physiological system predominantly regulates long-term blood pressure through sodium and water balance?

• Sympathetic nervous system
• Renin-angiotensin-aldosterone system
• Parasympathetic nervous system
• Coagulation cascade

Correct Answer: Renin-angiotensin-aldosterone system

Q2. According to common clinical classification, hypertension is defined as a sustained office blood pressure ≥ which value (mm Hg)?

• 120/80
• 130/80
• 140/90
• 150/95

Correct Answer: 140/90

Q3. Which antihypertensive drug class reduces angiotensin II formation by inhibiting angiotensin-converting enzyme?

• Angiotensin receptor blockers (ARBs)
• ACE inhibitors
• Beta-blockers
• Calcium channel blockers

Correct Answer: ACE inhibitors

Q4. A common adverse effect of ACE inhibitors related to bradykinin accumulation is:

• Hypokalemia
• Dry cough
• Hyperglycemia
• Peripheral neuropathy

Correct Answer: Dry cough

Q5. Which diuretic class is most effective for long-term hypertension management and reduces intravascular volume by inhibiting sodium reabsorption in the distal tubule?

• Loop diuretics
• Thiazide diuretics
• Potassium-sparing diuretics
• Osmotic diuretics

Correct Answer: Thiazide diuretics

Q6. Which antihypertensive drug is contraindicated in pregnancy due to risk of fetal renal damage?

• Hydralazine
• Labetalol
• ACE inhibitors
• Methyldopa

Correct Answer: ACE inhibitors

Q7. Beta-blockers lower blood pressure primarily by which mechanism?

• Vasodilation via smooth muscle calcium channel blockade
• Reduced cardiac output by blocking beta-1 receptors
• Inhibition of aldosterone synthesis
• Increased renal sodium excretion

Correct Answer: Reduced cardiac output by blocking beta-1 receptors

Q8. Which calcium channel blocker class is more cardioselective and often used for rate control in hypertension with tachyarrhythmias?

• Dihydropyridines (e.g., amlodipine)
• Phenylalkylamines (e.g., verapamil)
• Benzothiazepines (e.g., diltiazem)
• Organic nitrates

Correct Answer: Phenylalkylamines (e.g., verapamil)

Q9. A hypertensive emergency is best characterized by:

• BP >140/90 without symptoms
• Rapidly elevated BP with acute target organ damage
• Chronic untreated mild hypertension
• White coat hypertension

Correct Answer: Rapidly elevated BP with acute target organ damage

Q10. Which laboratory test is most important to monitor when prescribing ACE inhibitors or ARBs?

• Liver function tests
• Serum creatinine and potassium
• Complete blood count
• Thyroid function tests

Correct Answer: Serum creatinine and potassium

Q11. Which antihypertensive is a direct renin inhibitor that blocks conversion of angiotensinogen to angiotensin I?

• Aliskiren
• Captopril
• Losartan
• Spironolactone

Correct Answer: Aliskiren

Q12. Spironolactone lowers blood pressure by antagonizing which receptor?

• Beta-1 adrenergic receptor
• Mineralocorticoid (aldosterone) receptor
• Angiotensin II type 1 receptor
• Calcium channel receptor

Correct Answer: Mineralocorticoid (aldosterone) receptor

Q13. Which class of antihypertensives is associated with gout exacerbation due to reduced uric acid excretion?

• Thiazide diuretics
• ACE inhibitors
• Beta-blockers
• Calcium channel blockers

Correct Answer: Thiazide diuretics

Q14. A common pharmacodynamic interaction between ACE inhibitors and potassium-sparing diuretics is:

• Hypokalemia
• Hyperkalemia
• Hypoglycemia
• Increased hepatic metabolism

Correct Answer: Hyperkalemia

Q15. Which monitoring parameter helps assess efficacy of antihypertensive therapy over weeks?

• 24-hour ambulatory blood pressure monitoring
• Fasting lipid profile
• Random blood glucose
• Serum calcium

Correct Answer: 24-hour ambulatory blood pressure monitoring

Q16. In isolated systolic hypertension predominant in the elderly, which drug class is preferred?

• Thiazide diuretics and dihydropyridine calcium channel blockers
• Beta-blockers only
• Central alpha-2 agonists
• Direct renin inhibitors

Correct Answer: Thiazide diuretics and dihydropyridine calcium channel blockers

Q17. Which antihypertensive agent can cause gingival hyperplasia as an adverse effect?

• Hydrochlorothiazide
• Nifedipine
• Enalapril
• Spironolactone

Correct Answer: Nifedipine

Q18. For a patient with hypertension and benign prostatic hyperplasia, which class may provide dual benefit?

• ACE inhibitors
• Alpha-1 blockers (e.g., prazosin)
• Calcium channel blockers
• Mineralocorticoid receptor antagonists

Correct Answer: Alpha-1 blockers (e.g., prazosin)

Q19. Which mechanism explains orthostatic hypotension seen with alpha-1 adrenergic blockers?

• Reflex tachycardia from vasodilation
• Inhibition of peripheral vasoconstriction leading to venous pooling
• Direct myocardial depression
• Increased blood viscosity

Correct Answer: Inhibition of peripheral vasoconstriction leading to venous pooling

Q20. Which antihypertensive is considered first-line in patients with diabetes and albuminuria to reduce progression of nephropathy?

• ACE inhibitors
• Thiazide diuretics
• Beta-blockers
• Central alpha agonists

Correct Answer: ACE inhibitors

Q21. Which parameter increases with thiazide diuretics and may require monitoring?

• Serum potassium (hypokalemia)
• Serum sodium (hyponatremia)
• Serum uric acid
• All of the above

Correct Answer: All of the above

Q22. Which antihypertensive has a mechanism involving direct arteriolar vasodilation via opening potassium channels?

• Hydralazine
• Minoxidil
• Nitroprusside
• Amlodipine

Correct Answer: Minoxidil

Q23. Sodium nitroprusside lowers blood pressure mainly by releasing which molecule?

• Prostaglandin I2
• Nitric oxide
• Endothelin
• Angiotensin II

Correct Answer: Nitric oxide

Q24. A patient on propranolol develops bronchospasm. The likely reason is:

• Nonselective beta-blockade affecting beta-2 receptors in bronchial smooth muscle
• Excessive inhibition of ACE
• Hypersensitivity to lipophilic drugs
• Potentiation of calcium channel activity

Correct Answer: Nonselective beta-blockade affecting beta-2 receptors in bronchial smooth muscle

Q25. Which antihypertensive drug is commonly used intravenously for acute aortic dissection due to rapid BP control?

• Nitroprusside alone
• Hydralazine
• IV beta-blocker (e.g., esmolol) often with nitroprusside
• Oral ACE inhibitor

Correct Answer: IV beta-blocker (e.g., esmolol) often with nitroprusside

Q26. Which laboratory abnormality is most associated with spironolactone therapy?

• Hypokalemia
• Hyperkalemia
• Hyponatremia only
• Hypocalcemia

Correct Answer: Hyperkalemia

Q27. Which antihypertensive drug class may worsen insulin resistance and mask hypoglycemia symptoms?

• Calcium channel blockers
• Beta-blockers
• ACE inhibitors
• ARBs

Correct Answer: Beta-blockers

Q28. Which pharmacokinetic property is especially important when designing extended-release antihypertensive formulations?

• High first-pass metabolism
• Short elimination half-life
• Low protein binding
• Poor oral absorption

Correct Answer: Short elimination half-life

Q29. In resistant hypertension unresponsive to three agents including a diuretic, which additional drug is recommended?

• ACE inhibitor
• Spironolactone as mineralocorticoid receptor antagonist
• Increase dose of beta-blocker
• Discontinue diuretic

Correct Answer: Spironolactone as mineralocorticoid receptor antagonist

Q30. Which antihypertensive is known for reflex tachycardia when used as monotherapy due to potent arteriolar vasodilation?

• Hydralazine
• Amlodipine
• Beta-blocker
• ACE inhibitor

Correct Answer: Hydralazine

Q31. Which guideline-recommended initial therapy is often preferred in black patients without CKD or diabetes?

• ACE inhibitor
• Calcium channel blocker or thiazide diuretic
• Beta-blocker
• Central alpha agonist

Correct Answer: Calcium channel blocker or thiazide diuretic

Q32. What is the main pharmacological effect of ARBs compared to ACE inhibitors?

• ARBs increase bradykinin and cause cough
• ARBs directly block angiotensin II receptors without increasing bradykinin
• ARBs inhibit renin release
• ARBs are potassium-sparing diuretics

Correct Answer: ARBs directly block angiotensin II receptors without increasing bradykinin

Q33. Which medication class can cause a lupus-like syndrome as a rare adverse effect?

• Hydralazine
• ACE inhibitors
• Thiazide diuretics
• Calcium channel blockers

Correct Answer: Hydralazine

Q34. For managing hypertensive urgencies (elevated BP without organ damage), preferred approach is:

• Immediate IV antihypertensives to normalize BP within minutes
• Gradual BP reduction with oral agents over 24–48 hours
• No treatment required
• Emergency dialysis

Correct Answer: Gradual BP reduction with oral agents over 24–48 hours

Q35. Which adverse effect is characteristically associated with peripheral edema in patients taking dihydropyridine calcium channel blockers?

• Capillary hydrostatic pressure increase causing fluid extravasation
• Renal tubular damage
• Myocardial ischemia
• Hyperkalemia

Correct Answer: Capillary hydrostatic pressure increase causing fluid extravasation

Q36. Which antihypertensive would be most appropriate for a patient with tachycardia and hypertension following hyperthyroidism?

• ACE inhibitor
• Beta-blocker
• Thiazide diuretic
• Mineralocorticoid receptor antagonist

Correct Answer: Beta-blocker

Q37. Which investigation helps detect secondary causes of hypertension such as hyperaldosteronism?

• Plasma aldosterone-renin ratio
• Serum amylase
• ECG only
• Chest X-ray

Correct Answer: Plasma aldosterone-renin ratio

Q38. Which antihypertensive class is preferred in heart failure with reduced ejection fraction for mortality benefit?

• ACE inhibitors or ARBs and beta-blockers and mineralocorticoid receptor antagonists
• Calcium channel blockers alone
• Central alpha agonists
• Loop diuretics only

Correct Answer: ACE inhibitors or ARBs and beta-blockers and mineralocorticoid receptor antagonists

Q39. Which process contributes to isolated diastolic hypertension more than systolic hypertension?

• Arterial stiffness
• Increased peripheral vascular resistance due to vasoconstriction
• Decreased cardiac output
• Reduced blood volume

Correct Answer: Increased peripheral vascular resistance due to vasoconstriction

Q40. When counseling patients, which lifestyle modification has the greatest average BP-lowering effect?

• Weight reduction in overweight individuals
• Smoking cessation
• Moderate alcohol consumption
• Routine multivitamin use

Correct Answer: Weight reduction in overweight individuals

Q41. Which pharmacologic agent is commonly used to blunt sympathetic surge during perioperative hypertension?

• Clonidine
• Spironolactone
• Hydrochlorothiazide
• Losartan

Correct Answer: Clonidine

Q42. In renally impaired patients, which antihypertensive requires dose adjustment or caution because it is renally excreted?

• Metoprolol
• Enalapril
• Isosorbide dinitrate
• Nifedipine

Correct Answer: Enalapril

Q43. Which antihypertensive is associated with cyanide toxicity in prolonged high-dose IV infusion?

• Sodium nitroprusside
• Nitroglycerin
• Hydralazine
• Esmolol

Correct Answer: Sodium nitroprusside

Q44. Which antihypertensive mechanism increases renal blood flow and natriuresis by blocking angiotensin II type 1 receptors?

• Beta-blockers
• ARBs
• Calcium channel blockers
• Central alpha agonists

Correct Answer: ARBs

Q45. Which drug interaction increases risk of hyperkalemia when combined with ACE inhibitors?

• Loop diuretics
• Potassium supplements or potassium-sparing diuretics
• Thiazide diuretics
• Calcium channel blockers

Correct Answer: Potassium supplements or potassium-sparing diuretics

Q46. Which antihypertensive is used as first-line oral therapy in pregnancy-induced hypertension?

• ACE inhibitors
• Lisinopril
• Methyldopa
• Spironolactone

Correct Answer: Methyldopa

Q47. The mechanism of action of clonidine in lowering blood pressure is primarily:

• Peripheral alpha-1 blockade
• Central alpha-2 agonism reducing sympathetic outflow
• Direct myocardial contractility inhibition
• Inhibition of renin secretion exclusively

Correct Answer: Central alpha-2 agonism reducing sympathetic outflow

Q48. Which antihypertensive shows benefit in reducing stroke risk in clinical trials when used as monotherapy in elderly patients?

• Beta-blockers
• Thiazide diuretics
• Direct renin inhibitors
• Peripheral vasoconstrictors

Correct Answer: Thiazide diuretics

Q49. Which diagnostic tool is most specific for detecting left ventricular hypertrophy due to chronic hypertension?

• Electrocardiogram (ECG)
• Chest X-ray
• Echocardiography
• Serum troponin

Correct Answer: Echocardiography

Q50. In pharmacotherapy of hypertension, the rationale for combination therapy often includes:

• Using drugs with similar mechanisms to increase effect
• Targeting multiple pathophysiological mechanisms to achieve additive BP reduction with lower doses and fewer side effects
• Increasing pill burden intentionally
• Avoiding monitoring requirements

Correct Answer: Targeting multiple pathophysiological mechanisms to achieve additive BP reduction with lower doses and fewer side effects

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