Management of Hypertension: etiology and drug therapy MCQs With Answer

Introduction: Management of hypertension requires not only lowering blood pressure but understanding underlying etiology, pathophysiology, and rational drug selection to reduce cardiovascular and renal risk. This MCQ set is designed for M.Pharm students studying Pharmacotherapeutics I (MPP 102T) and focuses on causes of hypertension, mechanisms of antihypertensive agents, clinical indications, adverse effects, contraindications, and emergency management. Questions emphasize drug mechanisms, evidence-based choices in comorbid conditions (diabetes, pregnancy, renal disease, heart failure), and practical monitoring. Use these items to test and deepen your pharmacological reasoning, prepare for exams, and support therapeutic decision-making in clinical scenarios involving hypertension.

Q1. What is the most common pathophysiological basis for essential (primary) hypertension?

• Single-gene mutation causing sodium retention
• Multifactorial polygenic inheritance with environmental contributors
• Primary endocrine overproduction of aldosterone in most patients
• Autoimmune destruction of renal arterioles

Correct Answer: Multifactorial polygenic inheritance with environmental contributors

Q2. Which endocrine disorder is now recognized as one of the most common identifiable causes of secondary hypertension?

• Pheochromocytoma
• Primary aldosteronism (Conn’s syndrome)
• Cushing’s syndrome
• Hyperthyroidism

Correct Answer: Primary aldosteronism (Conn’s syndrome)

Q3. ACE inhibitors commonly cause a dry cough. What is the primary mechanism responsible for this adverse effect?

• Accumulation of bradykinin in the respiratory tract
• Direct irritation of bronchial mucosa by the drug
• Immunologic hypersensitivity reaction
• Induction of bronchial smooth muscle proliferation

Correct Answer: Accumulation of bradykinin in the respiratory tract

Q4. Which antihypertensive drug class is contraindicated during pregnancy because of fetal renal toxicity and oligohydramnios?

• Calcium channel blockers (dihydropyridine type)
• ACE inhibitors and ARBs
• Beta-adrenoceptor blockers like labetalol
• Centrally acting alpha-2 agonists like methyldopa

Correct Answer: ACE inhibitors and ARBs

Q5. In hypertensive emergencies with acute target-organ damage and impaired renal function, which intravenous agent is especially useful because it produces renal vasodilation via dopamine D1 receptor agonism?

• Sodium nitroprusside
• Fenoldopam
• Labetalol
• Hydralazine

Correct Answer: Fenoldopam

Q6. Which statement best describes the effect of thiazide diuretics on calcium handling?

• They increase urinary calcium excretion leading to hypocalcemia
• They decrease urinary calcium excretion and can raise serum calcium
• They have no significant effect on calcium transport
• They increase intestinal calcium absorption directly

Correct Answer: They decrease urinary calcium excretion and can raise serum calcium

Q7. Which beta-blocker is predominantly beta-1 selective at therapeutic doses and commonly used in hypertension with ischemic heart disease?

• Propranolol
• Metoprolol
• Labetalol
• Pindolol

Correct Answer: Metoprolol

Q8. Dihydropyridine calcium channel blockers such as amlodipine often cause peripheral edema and reflex tachycardia. What is the primary reason for the reflex tachycardia?

• Direct stimulation of cardiac beta receptors by the drug
• Rapid peripheral arteriolar vasodilation leading to baroreceptor-mediated sympathetic activation
• Inhibition of vagal tone at the sinoatrial node
• Renal retention of sodium provoking volume expansion

Correct Answer: Rapid peripheral arteriolar vasodilation leading to baroreceptor-mediated sympathetic activation

Q9. Which agent is recommended as an effective adjunct for resistant hypertension due to its antagonism of mineralocorticoid receptors?

• Hydrochlorothiazide
• Spironolactone
• Atenolol
• Nifedipine

Correct Answer: Spironolactone

Q10. Which antihypertensive carries a risk of cyanide toxicity during prolonged high-dose intravenous infusion and requires monitoring for lactic acidosis and cyanide accumulation?

• Sodium nitroprusside
• Nitroglycerin
• Hydralazine
• Labetalol

Correct Answer: Sodium nitroprusside

Q11. When initiating an ACE inhibitor or ARB in an outpatient with hypertension and chronic kidney disease, which laboratory parameters should be monitored closely?

• Complete blood count and liver function tests
• Serum potassium and serum creatinine/estimated GFR
• Thyroid-stimulating hormone and fasting glucose
• Serum magnesium and calcium

Correct Answer: Serum potassium and serum creatinine/estimated GFR

Q12. In a patient with hypertension and diabetes mellitus with albuminuria, which class of antihypertensives is preferred for renal protection?

• Alpha-1 blockers
• ACE inhibitors or ARBs
• Pure vasodilators like hydralazine alone
• Loop diuretics as monotherapy

Correct Answer: ACE inhibitors or ARBs

Q13. Angiotensin-converting enzyme inhibitors can precipitate acute kidney injury in patients with which renal vascular condition?

• Unilateral simple renal cysts
• Bilateral renal artery stenosis or significant stenosis of the single functioning kidney
• Diabetic microangiopathy without macrovascular disease
• Early IgA nephropathy

Correct Answer: Bilateral renal artery stenosis or significant stenosis of the single functioning kidney

Q14. Which of the following is a direct renin inhibitor used for hypertension that acts at the level of renin to block conversion of angiotensinogen to angiotensin I?

• Aliskiren
• Enalapril
• Sacubitril
• Spironolactone

Correct Answer: Aliskiren

Q15. For patients with significant volume overload and symptomatic heart failure with reduced ejection fraction, which diuretic class is preferred for rapid relief of pulmonary and peripheral edema?

• Thiazide diuretics (e.g., hydrochlorothiazide)
• Potassium-sparing diuretics alone
• Loop diuretics (e.g., furosemide)
• Carbonic anhydrase inhibitors (e.g., acetazolamide)

Correct Answer: Loop diuretics (e.g., furosemide)

Q16. Which antihypertensive is commonly used and considered safe as a first-line oral agent for managing pregnancy-related hypertension?

• ACE inhibitors such as enalapril
• Labetalol
• Angiotensin receptor blockers (e.g., losartan)
• Sodium nitroprusside

Correct Answer: Labetalol

Q17. Spironolactone can cause gynecomastia and menstrual irregularities. What is the pharmacological reason for these endocrine adverse effects?

• Excess aldosterone production caused by the drug
• Nonselective steroid receptor antagonism at androgen and progesterone receptors
• Inhibition of pituitary prolactin secretion
• Direct estrogen receptor agonism

Correct Answer: Nonselective steroid receptor antagonism at androgen and progesterone receptors

Q18. Which antihypertensive drug class is associated with increased serum uric acid and potential precipitation of gout?

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

Correct Answer: Thiazide diuretics

Q19. How is resistant hypertension defined in clinical practice?

• Blood pressure above goal despite lifestyle changes alone
• BP not at goal with three antihypertensives of different classes, one of which is a diuretic, at optimal doses
• Hypertension requiring any antihypertensive for control
• Elevated BP only during clinic visits

Correct Answer: BP not at goal with three antihypertensives of different classes, one of which is a diuretic, at optimal doses

Q20. Angioedema is a rare but serious adverse effect of ACE inhibitors. Which mediator is primarily implicated in ACE inhibitor–induced angioedema?

• Bradykinin
• Histamine from mast cell degranulation
• Leukotriene B4
• Prostaglandin E2

Correct Answer: Bradykinin

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