Hypertension Guidelines

Question 1

Step 1

Answer 1

• Under 55 and not Black African/African-Caribbean: ACE inhibitor (ACEi) or ARB.
• 55+ OR Black African/African-Caribbean (any age): Calcium-channel blocker (CCB).
• If initial drug isn’t tolerated:
  
  • Switch ACEi → ARB
  • CCB intolerance → thiazide-like diuretic (e.g., indapamide)

Question 2

Step 2

Answer 2

• Combine Step 1 drug classes appropriately (e.g., ACEi/ARB + CCB or thiazide-like diuretic).

Question 3

Step 3

Answer 3

• Triple therapy: ACEi/ARB + CCB + thiazide-like diuretic.

Question 4

Step 4 (resistant hypertension)

Answer 4

• If BP remains high on optimal doses of 3 drugs:
  
  • Add low-dose spironolactone if potassium ≤ 4.5 mmol/L
  • Or add α-blocker or beta-blocker if potassium > 4.5 mmol/L
  • Specialist advice if uncontrolled on 4 drugs
    Do not combine ACEi + ARB due to risk of adverse effects