PLAB 1 Hypertension Questions: 10 Free Practice MCQs

Ten PLAB 1-style hypertension questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 93 hypertension questions and many more across every topic.

Free timed mock exam

1. 1 / 10

   A 46-year-old has a clinic blood pressure of 152/94 mmHg on repeat measurement. They are able to use an ambulatory monitor.

   Which investigation should be offered to confirm hypertension?

   • A. Renal angiography
   • B. Ambulatory blood pressure monitoring
   • C. A 24-hour ECG
   • D. A single home reading next week
   Show answer

   Answer: B. Ambulatory blood pressure monitoring

   Why: For clinic blood pressure between 140/90 mmHg and 180/120 mmHg, offer ambulatory blood pressure monitoring to confirm the diagnosis. Offer home monitoring when ABPM is unsuitable or not tolerated.

   • A. This is not a routine confirmatory test for uncomplicated elevated clinic blood pressure.
   • C. ECG monitoring assesses cardiac rhythm, not whether hypertension is sustained.
   • D. A single reading does not meet the recommended home monitoring protocol.

   Sources: NICE NG136, recommendations 1.2.3 and 1.2.4

2. 2 / 10

   A 34-year-old is found to have persistent hypertension on repeated readings. No cause has yet been investigated.

   What additional step should be considered?

   • A. Specialist evaluation for secondary causes and a detailed benefit-risk review
   • B. Assume essential hypertension and never investigate further for a secondary cause
   • C. Wait until age 55 before starting any assessment or treatment
   • D. Start four antihypertensive medicines at once
   Show answer

   Answer: A. Specialist evaluation for secondary causes and a detailed benefit-risk review

   Why: NICE NG136 recommends considering specialist evaluation of secondary causes and a more detailed assessment of long-term treatment benefits and risks for adults under 40 with hypertension.

   • B. Hypertension at a young age is a reason to consider assessment for secondary causes.
   • C. The under-40 recommendation supports earlier evaluation rather than delaying it.
   • D. Young age alone does not justify immediate multidrug treatment without assessment.

   Sources: NICE NG136 recommendation 1.4.14

3. 3 / 10

   A 47-year-old without type 2 diabetes is starting step 1 treatment. They are not of Black African or African-Caribbean family origin and have no contraindication to renin-angiotensin system therapy.

   Which class is recommended initially?

   • A. An ACE inhibitor or an ARB
   • B. A calcium-channel blocker in every case
   • C. A thiazide-like diuretic as the only permitted first choice
   • D. No medication until age 55
   Show answer

   Answer: A. An ACE inhibitor or an ARB

   Why: For adults starting step 1 treatment who are under 55 and not of Black African or African-Caribbean family origin, NICE NG136 recommends an ACE inhibitor or an ARB. Check individual contraindications and safety guidance.

   • B. A CCB is recommended at step 1 for older adults or specified family origin groups without type 2 diabetes.
   • C. The guideline's step 1 choice for this subgroup is an ACE inhibitor or ARB.
   • D. Age under 55 is the group for whom an ACE inhibitor or ARB is recommended at step 1.

   Sources: NICE NG136 recommendation 1.4.32

4. Like these? UK.med has a bank of 1999 questions, plus timed mock exams. Free to start: App Store · Google Play

5. 4 / 10

   A 76-year-old without diabetes attends for hypertension review. They have no dizziness, falls or symptoms on standing.

   What clinic blood pressure target does NICE set for adults under 80?

   • A. Below 140/90 mmHg
   • B. Below 150/90 mmHg for all adults
   • C. Below 120/70 mmHg for every patient
   • D. Below 160/100 mmHg
   Show answer

   Answer: A. Below 140/90 mmHg

   Why: For adults with hypertension aged under 80, NICE NG136 recommends reducing clinic blood pressure to below 140/90 mmHg and maintaining it below that level, subject to condition-specific targets and clinical context.

   • B. The higher routine target applies to adults aged 80 and over, not this 76-year-old.
   • C. NG136 does not set this as the universal clinic target for uncomplicated hypertension.
   • D. This would leave the patient's blood pressure above the NICE target.

   Sources: NICE NG136 recommendation 1.4.20

6. 5 / 10

   A 65-year-old man has hypertension and takes amlodipine 5 mg daily. Clinic readings are 160/90 mmHg on two visits, and his home average is also above target. He has no diabetes, kidney disease or contraindication to renin-angiotensin system medicines.

   What is the most appropriate next step in his antihypertensive treatment?

   • A. Add an ACE inhibitor, for example ramipril, to the calcium-channel blocker
   • B. Replace amlodipine with a beta-blocker as routine second-line treatment
   • C. Stop drug treatment and use lifestyle advice alone
   • D. Refer directly for renal denervation before trying combination treatment
   Show answer

   Answer: A. Add an ACE inhibitor, for example ramipril, to the calcium-channel blocker

   Why: The elevated home and clinic readings confirm that blood pressure remains above target despite amlodipine. NICE recommends adding an ACE inhibitor, an ARB or a thiazide-like diuretic at step 2 for a person aged 55 or over taking a calcium-channel blocker. The option naming ramipril is therefore an appropriate next step; lifestyle advice should continue alongside treatment.

   • B. A beta-blocker is not the routine step-2 choice for uncomplicated primary hypertension.
   • C. Lifestyle advice should continue, but confirmed above-target blood pressure on treatment also needs medication review.
   • D. Renal denervation is not a routine next step before appropriate combination treatment and assessment of resistant hypertension.

   Sources: NICE NG136: Hypertension in adults, recommendations 1.4.32 to 1.4.39, current guidance

7. 6 / 10

   A 65-year-old man takes amlodipine 5 mg daily for primary hypertension. His clinic blood pressure is 132/78 mmHg and his 7-day home average is 130/76 mmHg. He reports no adverse effects and has no new cardiovascular symptoms.

   What is the appropriate management at this review?

   • A. Increase amlodipine to 10 mg to reach a lower target for every adult
   • B. Refer to a hypertension specialist for routine dose adjustment
   • C. Add a thiazide-like diuretic because he is already taking a CCB
   • D. Continue amlodipine and monitor blood pressure at routine review
   Show answer

   Answer: D. Continue amlodipine and monitor blood pressure at routine review

   Why: For adults under 80, NICE generally aims for clinic pressure below 140/90 mmHg and home or ambulatory average below 135/85 mmHg. This patient's readings are within both targets and treatment is tolerated. Continue his current medicine with routine review.

   • A. The recorded pressure is already below the usual NICE target for an adult under 80, so routine dose escalation is not needed.
   • B. His pressure is controlled and he has no feature requiring specialist review.
   • C. A second agent is considered when pressure remains above target despite the first agent, which is not the case here.

   Sources: NICE NG136: Hypertension in adults, 2019

8. 7 / 10

   A 28-year-old at 14 weeks' gestation has chronic hypertension. Her booking blood pressure is 152/98 mmHg. She stopped ramipril when her pregnancy test was positive and has no asthma, bradycardia or other contraindication to labetalol.

   What is the most appropriate management now?

   • A. Continue ramipril and add aspirin 75 mg daily.
   • B. Stop all antihypertensive treatment and recheck blood pressure at 20 weeks.
   • C. Start methyldopa as first choice and arrange routine midwife follow-up only.
   • D. Start labetalol, arrange specialist review and prescribe aspirin from 12 weeks.
   Show answer

   Answer: D. Start labetalol, arrange specialist review and prescribe aspirin from 12 weeks.

   Why: Her chronic hypertension and booking pressure of 152/98 mmHg warrant pregnancy-compatible antihypertensive treatment. NICE advises specialist review, considers labetalol a treatment option, and recommends aspirin from 12 weeks for chronic hypertension. Ramipril should be stopped and replaced with a suitable medicine.

   • A. Ramipril should not be used in pregnancy, and aspirin alone would leave her raised blood pressure untreated.
   • B. A booking pressure above the treatment threshold needs active management rather than delayed review.
   • C. Methyldopa is an option when preferred agents are unsuitable, but specialist input is still indicated.

   Sources: NICE NG133, Hypertension in pregnancy: diagnosis and management, recommendations 1.3.1 to 1.3.11, 2019

9. 8 / 10

   A 67-year-old woman without diabetes has persistent clinic blood pressure readings around 158/92 mmHg despite taking amlodipine 10 mg daily. Adherence and measurement technique have been checked, and she has no contraindication to an ACE inhibitor, ARB or thiazide-like diuretic.

   Which is the most appropriate next medication step for this patient?

   • A. Increase amlodipine to 10 mg daily and reassess for ankle oedema
   • B. Refer routinely to a hypertension specialist before adjusting primary care treatment
   • C. Add a thiazide-like diuretic, such as indapamide
   • D. Add a beta-blocker as the standard second-line drug
   Show answer

   Answer: C. Add a thiazide-like diuretic, such as indapamide

   Why: His clinic pressure remains above target despite a calcium-channel blocker. NICE NG136 recommends step 2 treatment with an ACE inhibitor, ARB or thiazide-like diuretic for adults aged 55 or over without type 2 diabetes who remain uncontrolled on a CCB. A thiazide-like agent such as indapamide is an appropriate choice; check adherence, measurement and contraindications as part of review.

   • A. Dose titration can be considered, but NICE step 2 treatment generally adds a second drug when pressure remains above target on a CCB.
   • B. This uncomplicated case can be managed in primary care using the stepwise NICE treatment pathway.
   • D. Beta-blockers are not the routine step 2 addition in this uncomplicated hypertension scenario.

   Sources: NICE NG136: Hypertension in adults, 2019

10. 9 / 10

    A 67-year-old with confirmed stage 1 hypertension is eligible to discuss medication but is concerned about adverse effects and prefers to avoid tablets if possible.

    How should the clinician proceed?

    • A. Discuss personal cardiovascular risk, benefits, harms and the option of no medication
    • B. Prescribe without explaining alternatives
    • C. Stop offering lifestyle advice if medication is declined
    • D. Tell the patient that treatment eliminates all cardiovascular risk, so declining it is unsafe
    Show answer

    Answer: A. Discuss personal cardiovascular risk, benefits, harms and the option of no medication

    Why: NICE NG136 asks clinicians to discuss individual cardiovascular risk and preferences, including no treatment, and to explain risks and benefits before starting medication. Continue lifestyle support whichever choice is made.

    • B. NICE recommends explaining risks and benefits and discussing the person's preferences.
    • C. Lifestyle advice and support remain appropriate whether or not medication is started.
    • D. Medication reduces risk but does not remove the need for accurate, balanced counseling.

    Sources: NICE NG136 recommendation 1.4.11

11. 10 / 10

    A 55-year-old Afro-Caribbean male presents for a routine check-up. His blood pressure is consistently 155/95 mmHg on three separate occasions. He has no other comorbidities and his renal function is normal.

    According to NICE guidelines (NG136), what is the most appropriate initial antihypertensive medication?

    • A. Amlodipine
    • B. Ramipril
    • C. Bendroflumethiazide
    • D. Bisoprolol
    Show answer

    Answer: A. Amlodipine

    Why: NICE NG136 recommends a Calcium Channel Blocker (CCB) like Amlodipine as first-line therapy for patients aged over 55 OR of Black African or African-Caribbean family origin of any age.

    • B. ACE inhibitors are first-line for patients <55 years who are not of Black African or African-Caribbean family origin.
    • C. Thiazide-like diuretics (e.g. Indapamide) are second-line or alternative first-line if CCBs are not tolerated, but Amlodipine is preferred initially.
    • D. Beta-blockers are no longer first-line for uncomplicated hypertension.

    Sources: NICE NG136

Exam-style questions written by MedHub for practice. They are not official exam questions.