# Hypertension Management

> Hypertension for FMGE: diagnostic thresholds, <140/90 targets, A+C+D drug strategy, India Hypertension Control Initiative and emergency management.

- Canonical URL: https://prepelephant.com/topics/fmge/medicine/hypertension-management
- Exam / course: FMGE · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Hypertension Management", PrepElephant, https://prepelephant.com/topics/fmge/medicine/hypertension-management

## Direct answer

Hypertension is diagnosed when clinic blood pressure is 140/90 mmHg or above, confirmed by repeat visits, home readings or ambulatory monitoring, and Indian practice treats to below 140/90 mmHg for most patients. Management begins with lifestyle change — salt restriction, exercise, weight reduction, alcohol moderation — and most patients need drug therapy, starting with an angiotensin receptor blocker or ACE inhibitor, a calcium channel blocker or a thiazide-like diuretic, alone or in early combination. The India Hypertension Control Initiative supports protocol-driven, single-pill combination treatment under the national non-communicable disease programme.

## What you must remember

- Diagnosis requires elevated readings on separate occasions: clinic 140/90 mmHg or above, or 24-hour ambulatory daytime average at or above 135/85; grade severity and assess total cardiovascular risk, not the numbers alone.
- Lifestyle prescription: salt below about 5 g daily (Indian intakes are far higher, much hidden in pickles and packaged food), 150 minutes of moderate activity weekly, weight reduction and tobacco cessation.
- First-line classes are the A-C-D trio — ACE inhibitor or angiotensin receptor blocker, calcium channel blocker (amlodipine), and thiazide-like diuretic — with combination therapy preferred for pressures 20/10 mmHg or more above target.
- Screen every hypertensive patient for target-organ damage and risk: urine protein, serum creatinine with electrolytes, fasting glucose and lipids, ECG, and fundoscopy — and seek secondary causes in the young (under 30) or suddenly resistant case.
- Secondary-cause reflexes: obstructive sleep apnoea and renal disease are commonest, then renal artery stenosis, phaeochromocytoma (episodic headache, sweating, palpitations) and primary aldosteronism — check potassium before blaming essential resistance.
- Hypertensive emergency (severe hypertension with acute target-organ damage — encephalopathy, dissection, pulmonary oedema, eclampsia) needs controlled intravenous lowering; urgency without organ damage is managed with oral agents and early review, not rapid falls.
- Beta-blockers are not first-line uncomplicated therapy but are preferred with ischaemic heart disease or heart failure, and combination ACE inhibitor with angiotensin receptor blocker is avoided.

## Common confusion

The commonest error is treating the white-coat phenomenon: a single high clinic reading never starts lifelong therapy without out-of-office confirmation. Candidates also chase an imagined emergency in asymptomatic severe hypertension and lower pressure too fast, risking cerebral hypoperfusion — organ damage, not the number, defines the emergency. Finally, do not reflexively add drugs before checking adherence and the secondary-cause screen; resistant hypertension is defined on three drugs including a diuretic at full dose.

## Exam-focused takeaway

FMGE hypertension questions test the threshold, the target and the first drug: 140/90 diagnoses, most Indians are treated to below it, and the answer to "first-line" is the A-C-D trio with early single-pill combination, as promoted by the India Hypertension Control Initiative. Learn the emergency-versus-urgency split by organ damage and the young-patient trigger for secondary screening. Stems pairing hypokalaemia with resistant hypertension point to primary aldosteronism, and episodic triads point to phaeochromocytoma — both recycled favourites.

## Frequently asked questions

### What is the usual treatment target in Indian practice?

Below 140/90 mmHg for most patients, tighter where tolerated in selected high-risk groups.

### Which drug classes are first line?

An ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or a thiazide-like diuretic — combined early when blood pressure is well above target.

### What separates a hypertensive emergency from urgency?

Acute target-organ damage — encephalopathy, dissection, pulmonary oedema, eclampsia — defines the emergency needing intravenous therapy; urgency is managed orally.

### When should secondary hypertension be suspected?

In patients under 30, with resistant or suddenly severe hypertension, or with clues such as hypokalaemia, abdominal bruits or daytime somnolence.

### What is the India Hypertension Control Initiative?

A programme partnership, under the national NCD programme, promoting standardised protocols and single-pill combination therapy to raise blood-pressure control rates across Indian districts.