A 60-year-old male was admitted for a 2-day history of newly documented repeated severe chest pain lasting 10–15 min.

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EXPLANATION
There exist four stages of pericarditis :
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR),  
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks),  
Stage 3 – flattened T waves become inverted (3 to several weeks) and
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards). Spodick’s

How can you differentiate between Pericarditis and STEMI:  
1) STE in pericarditis are concave; in AMI - convex or horizontal,  
2) STE in pericarditis - diffuse; in AMI - localised,  
3) Pericarditis - PR depression; AMI - Q waves,  
4) Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE ECG manifestation.
EXPLANATION
There exist four stages of pericarditis :
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR),  
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks),  
Stage 3 – flattened T waves become inverted (3 to several weeks) and
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards). Spodick’s

How can you differentiate between Pericarditis and STEMI:  
1) STE in pericarditis are concave; in AMI - convex or horizontal,  
2) STE in pericarditis - diffuse; in AMI - localised,  
3) Pericarditis - PR depression; AMI - Q waves,  
4) Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE ECG manifestation.
EXPLANATION
There exist four stages of pericarditis :
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR),  
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks),  
Stage 3 – flattened T waves become inverted (3 to several weeks) and
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards). Spodick’s

How can you differentiate between Pericarditis and STEMI:  
1) STE in pericarditis are concave; in AMI - convex or horizontal,  
2) STE in pericarditis - diffuse; in AMI - localised,  
3) Pericarditis - PR depression; AMI - Q waves,  
4) Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE ECG manifestation.
EXPLANATION
There exist four stages of pericarditis :
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR),  
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks),  
Stage 3 – flattened T waves become inverted (3 to several weeks) and
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards). Spodick’s

How can you differentiate between Pericarditis and STEMI:  
1) STE in pericarditis are concave; in AMI - convex or horizontal,  
2) STE in pericarditis - diffuse; in AMI - localised,  
3) Pericarditis - PR depression; AMI - Q waves,  
4) Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE ECG manifestation.
EXPLANATION
There exist four stages of pericarditis :
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR),  
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks),  
Stage 3 – flattened T waves become inverted (3 to several weeks) and
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards). Spodick’s

How can you differentiate between Pericarditis and STEMI:  
1) STE in pericarditis are concave; in AMI - convex or horizontal,  
2) STE in pericarditis - diffuse; in AMI - localised,  
3) Pericarditis - PR depression; AMI - Q waves,  
4) Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE ECG manifestation.
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Correct! SCORE2 is recommended for individuals aged 40–69 years with elevated BP, provided they are not already classified as high risk due to conditions like CKD, diabetes, or established CVD. (Class I, Level B).

Correct! SCORE2-OP is recommended for individuals aged ≥70 years with elevated BP, provided they are not already at high risk due to pre-existing conditions. (Class I).

Incorrect. SCORE2 and SCORE2-OP are not used for individuals already classified as high risk due to CKD, diabetes, or established CVD.

Incorrect. SCORE2 is not designed for individuals under 40 years old; it is used for individuals aged 40–69 years.

Incorrect. Renal function should be assessed in all hypertensive patients, regardless of hypertension duration.

Incorrect. While cardiovascular risk factors increase the likelihood of kidney disease, the recommendation applies to all hypertensive patients.

Incorrect. Signs of kidney disease are an indication for further evaluation, but all hypertensive patients should be assessed for renal damage.

Correct! Measuring serum creatinine, eGFR, and urine ACR is recommended for all patients with hypertension to detect hypertension-mediated organ damage. (Class I, Level A).

Incorrect. Long-standing hypertension increases the risk of hypertensive retinopathy, but fundoscopy is not routinely recommended for all such patients.

Correct! Fundoscopy is recommended in patients with BP >180/110 mmHg in hypertensive emergency or malignant hypertension. (Class I, Level B).

Correct! Hypertensive patients with diabetes should undergo fundoscopy to assess hypertension-mediated retinal damage. (Class I, Level B).

Incorrect. Fundoscopy is not a routine screening test for all hypertensive patients; it is reserved for specific high-risk groups.

Correct! Resistant hypertension is defined as BP that remains uncontrolled despite treatment with three drugs, including a diuretic, a RAS blocker, and a calcium channel blocker. (Definition-based).

Correct! Office systolic and/or diastolic BP values must remain ≥140/90 mmHg despite maximally tolerated doses of three medications. (Definition-based).

Incorrect. Office BP measurements alone are insufficient; confirmation with HBPM (home blood pressure monitoring) or ABPM (ambulatory blood pressure monitoring) is required.

Correct! Lifestyle modifications, such as dietary changes, sodium restriction, and physical activity, should already be in place before diagnosing resistant hypertension. (Definition-based).

Incorrect. Resistant hypertension is not a disease but an indicator of high CVD risk, often requiring evaluation for secondary hypertension.

Correct! Pseudo-resistant hypertension, including cases due to non-adherence to medication, must be ruled out before diagnosing true resistant hypertension. (Guideline-based).

Correct! In patients with eGFR <30 mL/min/1.73 m², a loop diuretic must be adequately up-titrated before confirming resistant hypertension. (Guideline-based).

Correct! The ESC Guidelines do not use the terms ‘controlled resistant hypertension’ (BP controlled on ≥4 meds) or ‘refractory hypertension’ (BP uncontrolled on ≥5 meds). (Guideline-based).

Incorrect. Increasing medication doses without further investigation may overlook underlying causes such as secondary hypertension.

Correct! Patients with resistant hypertension should be considered for referral to specialized centres for further evaluation. (Class IIa, Level B).

Incorrect. The ESC Guidelines do not define resistant hypertension based on requiring ≥5 medications; additional assessment is needed before intensifying therapy.

Incorrect. Resistant hypertension should be confirmed with out-of-office BP measurements (HBPM or ABPM) to rule out white-coat hypertension.

Incorrect. The 2024 guidelines simplify BP classification, replacing the 2018 categories. (Class I, Level B).

Correct! The 2024 ESC Guidelines introduce a new classification system to guide treatment more effectively. (Class I, Level B).

Incorrect. Office BP is still used, but home/ambulatory BP remains important for diagnosis.

Incorrect. BP classification remains essential for treatment decisions.

Incorrect. The 2024 guidelines lowered the BP target compared to 2018. (Class I, Level A).

Correct! The 2024 ESC Guidelines recommend a lower systolic BP target of 120–129 mmHg, provided treatment is well tolerated. (Class I, Level A).

Incorrect. This was the initial BP target from the 2018 guidelines, but the 2024 version now recommends a lower systolic BP target of 120–129 mmHg.

Incorrect. This was the secondary BP target in the 2018 guidelines, but the 2024 guidelines have shifted to a stricter range of 120–129 mmHg.

Correct! The 2024 ESC Guidelines recommend initiating drug treatment at BP ≥140/90 mmHg in women with gestational hypertension, without requiring additional conditions. (Class I, Level B).

Incorrect. The 2018 guidelines required subclinical organ damage for treatment initiation, but this criterion has been removed in 2024. (Class I, Level C in 2018, no longer required in 2024).

Incorrect. The 2018 guidelines also required symptoms for treatment initiation, but this requirement is no longer included in 2024. (Class I, Level C in 2018, no longer required in 2024).

Incorrect. The BP threshold remains ≥140/90 mmHg; it has not been lowered to 130/80 mmHg in 2024.

Incorrect. The BP threshold has been lowered in 2024; treatment is now recommended at ≥130/80 mmHg. (Class I, Level A).

Correct! The 2024 ESC Guidelines recommend initiating antihypertensive drug treatment at BP ≥130/80 mmHg after up to 3 months of lifestyle changes to reduce CVD risk. (Class I, Level A).

Incorrect. BP ≥130/80 mmHg alone is not an automatic indication for treatment; the guidelines recommend a trial of lifestyle intervention first. (Class I, Level A).

Incorrect. Symptoms are not required to start BP-lowering treatment, as hypertension in diabetes can be asymptomatic but still increase CVD risk.

Incorrect. Monotherapy is not required for most patients with BP ≥140/90 mmHg—combination therapy is preferred. (Class I, Level A).

Correct! Combination therapy is recommended for most patients with BP ≥140/90 mmHg, as it provides better BP control than monotherapy. (Class I, Level A).

Correct! The preferred first-line combinations are a RAS blocker (ACE-I or ARB) plus a dihydropyridine CCB or a diuretic. (Class I, Level A).

Correct! In older adults (≥85 years), those with symptomatic orthostatic hypotension, moderate-to-severe frailty, or BP 120–139/70–89 mmHg with another indication, treatment may need to be individualized. (Class I, Level A).

Correct! High-risk ethnicity (e.g., South Asian background) is a recognized risk modifier that can up-classify individuals with elevated BP and borderline 10-year CVD risk. (Class IIa, Level B).

Incorrect. Family history of premature atherosclerotic CVD (not late-onset) is a risk modifier, but late-onset disease is not emphasized in the guidelines.

Correct! Auto-immune inflammatory disorders and HIV are considered risk modifiers for cardiovascular disease risk stratification. (Class IIa, Level B).

Correct! Socio-economic deprivation and severe mental illness are recognized as contributing to increased cardiovascular risk. (Class IIa, Level B).

Correct! In patients with elevated BP (120/70–139/89 mmHg), monotherapy may be preferred, especially if there is a concomitant indication for treatment. (Class I, Level A).

Correct! Monotherapy is preferred in patients with moderate-to-severe frailty to reduce the risk of adverse effects. (Class I, Level A).

Correct! Patients with symptomatic orthostatic hypotension should be treated cautiously with monotherapy to avoid excessive BP reduction. (Class I, Level A).

Correct! For patients aged ≥85 years, monotherapy is often preferred due to increased risk of side effects with combination therapy. (Class I, Level A).

Correct! Screening for primary aldosteronism by measuring renin and aldosterone should be considered in all adults with BP ≥140/90 mmHg. (Class IIa, Level B).

Correct! Screening for secondary hypertension is recommended when suggestive signs, symptoms, or a relevant medical history are present. (Class I, Level B).

Incorrect. Screening for primary aldosteronism is not required for all hypertensive patients but should be considered for those with confirmed BP ≥140/90 mmHg. (Class IIa, Level B).

Incorrect. Screening is not routinely recommended for normotensive individuals based on family history alone.

Correct! First-line treatment is a low-dose double combination of ACEi or ARBs with either CCBs or diuretics, with some exceptions. (Class I).

Correct! BP should be reassessed at 1-3 months (assessment at 1 month preferred if possible), and if controlled, follow-up should occur annually.

Correct! If BP is not controlled after 1–3 months, escalation to triple therapy is recommended, and if still insufficient, maximally tolerated triple therapy should be used. (Class I).

Correct! Beta-blockers should be added at any step when specific indications (angina, post-MI, systolic HF, or heart rate control) exist. (Class I).

Correct! If BP is not controlled with three-drug therapy, spironolactone should be considered as an add-on. (Class IIa, Level B).

Correct! If spironolactone is ineffective or not tolerated, eplerenone should be considered as an alternative. (Class IIa, Level B).

Correct! Other options for uncontrolled BP include beta-blockers, centrally acting agents, alpha-blockers, hydralazine, or potassium-sparing diuretics. (Class IIa, Level B).

Incorrect. Combining two RAS blockers (ACE inhibitor and ARB) is not recommended due to increased risk of adverse effects. (Class III, Level A).

Correct! For individuals with elevated BP and low/medium CVD risk, lifestyle measures alone are recommended to reduce CVD risk. (Class I, Level B).

Correct! For individuals with high CVD risk, BP-lowering medication should be started after 3 months of lifestyle intervention if BP remains ≥130/80 mmHg. (Class I, Level A).

Incorrect! BP-lowering treatment should be initiated in all hypertensive patients (BP ≥140/90 mmHg), irrespective of CVD risk, lifestyle measures and pharmacological BP-lowering treatment are initiated promptly to reduce CVD risk.. (Class I, Level A).

Correct! BP-lowering treatment should be continued lifelong, even in patients over 85 years old, as long as it is well tolerated. (Class I, Level A).

Incorrect! A systolic BP target of 120–129 mmHg is the recommended goal for most patients, while <140 mmHg applies only to specific groups.

Correct! When achieving a systolic BP of 120–129 mmHg is not possible due to poor tolerance, BP should be reduced as much as reasonably achievable (ALARA principle). (Class I, Level A).

Correct! For patients with pre-treatment symptomatic orthostatic hypotension or age ≥85 years, a BP target of <140 mmHg should be considered instead. (Class IIa, Level C).

Correct! For patients with clinically significant frailty or a life expectancy of <3 years, a more lenient BP target may be considered. (Class IIb, Level C).

Correct! In individuals diagnosed with hypertension before 40, a full secondary hypertension screening is recommended, except for obese young adults. (Class I, Level B).

Correct! In obese young adults with hypertension, obstructive sleep apnea evaluation should be the first step before broader secondary hypertension screening. (Class I, Level B).

Incorrect! SCORE2 has not been validated for individuals younger than 40 years, so it is not recommended for CVD risk assessment in this group.

Correct! Screening for HMOD may be considered in young individuals with elevated BP without other CVD risk factors to determine the need for treatment. (Class IIb).

Correct! Drug treatment is recommended for women with gestational hypertension if systolic BP is ≥140 mmHg or diastolic BP is ≥90 mmHg. (Class I, Level B).

Correct! BP should be lowered below 140/90 mmHg but not below 80 mmHg for diastolic BP in women with chronic or gestational hypertension. (Class I, Level C).

Correct! Low- to moderate-intensity exercise is recommended for all pregnant women without contraindications and should be done in consultation with an obstetrician. (Class I, Level C).

Correct! Severe hypertension (SBP ≥160 mmHg or DBP ≥110 mmHg) in pregnancy can indicate an emergency, and immediate hospitalization should be considered. (Class IIa, Level C).

Correct! Moderately frail individuals need help with outdoor activities and some indoor tasks but are not fully dependent.

Correct! Severely frail individuals require full assistance for personal care but remain relatively stable.

Incorrect! Being unlikely to recover from minor illnesses is a characteristic of very severe frailty, not severe frailty.

Correct! Severely frail individuals are entirely dependent, while moderately frail individuals may still manage some self-care tasks.

Correct! Frailty screening helps guide BP treatment decisions and should be considered before initiating therapy. (Class IIa, Level C).

Incorrect! Low-dose diuretics may be considered if tolerated, but long-acting dihydropyridine CCBs or RAS inhibitors are preferred first-line treatments in frail or very old patients. (Class IIa, Level B).

Correct! A shared decision-making approach is important when determining BP treatment goals for frail patients. (Class IIa, Level C).

Incorrect! Initiation of BP-lowering therapy is recommended in very old or frail patients, but with careful selection of medications and individualized treatment goals.

Incorrect! Office BP ≥140/90 mmHg is classified as hypertension, not elevated BP.

Correct! Office BP 120-139/70-90 mmHg is considered elevated BP, according to the 2024 Guidelines.

Incorrect! 24-hour ambulatory blood pressure monitoring (ABPM) threshold for hypertension is ≥130/80 mmHg, not for elevated BP. (ABPM = ambulatory blood pressure monitoring.)

Incorrect! Night-time ABPM ≥120/70 mmHg is classified as hypertension, not elevated BP.

Correct! Patients with isolated diastolic hypertension have a slightly increased relative risk for CVD ranging from 5% to 30%.

Correct! Young individuals with isolated systolic hypertension often have white-coat hypertension, leading to overestimation of their actual BP.

Correct! Beta-blockers should be avoided in patients with isolated systolic hypertension or arterial stiffness, as they increase stroke volume and can worsen outcomes.

Incorrect! There is little to no high-quality trial evidence that achieving both systolic BP <120 mmHg and diastolic BP <70 mmHg improves CVD prognosis.

Incorrect! Stopping BP-lowering therapy completely is not recommended. Instead, switching to alternative BP medications should be considered.

Correct! Non-pharmacological approaches should be pursued first for patients with supine hypertension and orthostatic hypotension. (Class I, Level A).

Correct! For patients with supine hypertension and orthostatic hypotension, switching BP-lowering medications is preferred over simply reducing therapy intensity. (Class I, Level A).

Correct! Testing for orthostatic hypotension before modifying BP-lowering treatment is recommended by measuring BP after standing. (Class I, Level B).

Correct! BP-lowering medication is recommended for patients with diabetes if office BP remains ≥130/80 mmHg despite 3 months of lifestyle changes. (Class I, Level A).

Incorrect! BP-lowering drugs are also recommended if office BP is 130–139/80–89 mmHg and the patient has a predicted 10-year CVD risk ≥10% or high-risk conditions. (Class I, Level A).

Correct! For patients with diabetes receiving BP-lowering treatment, the systolic BP target is 120–129 mmHg if tolerated. (Class I, Level A).

Correct! BP-lowering treatment is recommended if BP is 130–139/80–89 mmHg and the patient has high cardiovascular risk, such as a 10-year CVD risk ≥10% or high-risk conditions. (Class I, Level A).

Correct! Beta-blockers and RAS blockers are recommended for BP management in patients with a history of myocardial infarction. (Class I, Level A).

Correct! Beta-blockers and/or CCBs are recommended as part of BP-lowering treatment for hypertensive patients with symptomatic angina. (Class I, Level A).

Correct! For symptomatic HFrEF or HFmrEF, BP-lowering treatments including ACE inhibitors (or ARBs if ACE inhibitors are not tolerated), ARNi, beta-blockers, MRAs, and SGLT2 inhibitors are recommended. (Class I, Level A).

Correct! SGLT2 inhibitors are recommended for hypertensive patients with symptomatic HFpEF to improve outcomes, in addition to their modest BP-lowering properties. (Class I, Level A).

Correct! A BP-lowering strategy with a RAS blocker plus a CCB or a thiazide-like diuretic is recommended for stroke prevention. (Class I, Level A).

Incorrect! BP-lowering treatment is recommended in stroke patients with confirmed BP ≥130/80 mmHg to reduce cardiovascular outcomes. (Class I).

Correct! For patients with a history of TIA or stroke and BP ≥130/80 mmHg, a systolic BP target of 120–129 mmHg is recommended, provided treatment is tolerated. (Class I).

Incorrect! CCBs are a recommended component of BP-lowering therapy for preventing recurrent stroke. (Class I, Level A).

Correct! Vascular endothelial growth factor inhibitors cause hypertension in 80-90% of patients. (ESC Guidelines on Cardio-Oncology, 2022).

Incorrect! There are no specific, evidence-based hypertension management guidelines for cancer patients. Management follows general hypertension guidelines. (ESC Guidelines, 2024).

Correct! Hypertension caused by anticancer drugs is often dose-limiting, and in some cases, BP may return to normal after stopping therapy. (ESC Guidelines, 2024).

Correct! Hypertension in cancer patients should be managed as in the general population, requiring multidisciplinary care. (ESC Guidelines, 2024).

Correct! Hypertension is defined by a 24-hour ABPM threshold of ≥130/80 mmHg. (Class I, Level B).

Correct! Daytime ABPM threshold for hypertension is ≥135/85 mmHg. (Class I, Level B).

Correct! Night-time ABPM threshold for hypertension is ≥120/70 mmHg. (Class I, Level B).

Incorrect! Office BP 120-139/70–90 mmHg is classified as elevated BP, not hypertension.

Correct! The 2024 Guidelines define hypertension as a confirmed office systolic BP of ≥140 mmHg or diastolic BP of ≥90 mmHg. (Class I, Level B).

Correct! To confirm the diagnosis, out-of-office BP measurements using HBPM or ABPM are recommended. (Class I, Level B).

Incorrect! One repeat office BP measurement alone is not sufficient; out-of-office BP measurement or additional office visits are required.

Correct! For individuals with an office BP of 120–139/70–89 mmHg, assessing their CVD risk is recommended. (Class I, Level B).

Incorrect. While closer monitoring may be needed in high-risk cases, the guideline specifically recommends reassessment within 1 year.

Correct! A repeat BP measurement and risk assessment within 1 year should be considered for individuals who do not yet meet BP-lowering treatment thresholds. (Class IIa, Level C).

Incorrect. Waiting for symptoms can delay early intervention, as hypertension is often asymptomatic.

Incorrect. Follow-up is still necessary, even if BP is stable, to reassess cardiovascular risk over time.

Incorrect. Fasting blood glucose and HbA1c are recommended to assess cardiovascular risk and metabolic disorders.

Incorrect. These tests help screen for secondary hypertension causes such as hyperaldosteronism and thyroid disorders.

Correct! High-sensitivity cardiac troponin and/or NT-proBNP are optional tests that may be used as clinically indicated in the initial work-up of hypertension to assess hypertension-mediated organ damage (HMOD) or established cardiovascular disease. (Optional Test).

Incorrect. Albumin-to-creatinine ratio is necessary to assess hypertensive target organ damage and cardiovascular risk.

Correct! Opportunistic screening every 3 years is recommended for adults under 40 years. (Class IIa, Level C).

Incorrect. Opportunistic screening for BP in adults under 40 years is recommended every 3 years, not 5 years. (Class IIa, Level C).

Correct! Annual BP screening is recommended for adults aged 40 years and older. (Class IIa, Level C).

Correct! For individuals with elevated BP but not meeting treatment thresholds, repeat BP measurement and risk assessment should be considered within 1 year. (Class IIa, Level C).

Correct! For individuals at increased CVD risk with office BP 120–139/70–89 mmHg, out-of-office BP measurement is recommended. (Class I, Level B).

Correct! If screening BP is 140–159/90–99 mmHg, ABPM and/or HBPM should be used to confirm hypertension whenever feasible. (Class I, Level B).

Incorrect. Hypertension diagnosis cannot be based on initial office BP measurements alone; repeated measurements on more than one visit are required if ABPM or HBPM is not feasible. (Class I, Level B).

Correct! For screening BP ≥180/110 mmHg, hypertensive emergency must be excluded before diagnosis. (Class I, Level C).