HTN Medications Algorithm

Question 1

HTN + DM 2 - Step 1

Answer 1

ACEi or ARB

Question 2

HTN + DM 2 - Step 2

Answer 2

ACEi or ARB + CCB or Thiazide Like Diuretic

Question 3

All HTN - Step 4

Answer 3

Confirm resistant hypertension: confirm elevated BP with ABPM or HBPM, check for postural hypotension and discuss adherence.

Consider seeking expert advice or adding a:
* Low-dose spironolactone if the blood potassium level is ≤4.5 mmol/l
* Alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l

Seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs

Question 4

HTN Age <55 and not Black African or African-Caribbean Family Origin - Step 1

Answer 4

ACEi or ARB

Question 5

HTN Age <55 and not Black African or African-Caribbean Family Origin - Step 2

Answer 5

ACEi or ARB + CCB or Thiazide Like Diuretic

Question 6

HTN + Age 55 or over - Step 1

Answer 6

CCB

Question 7

HTN + Age 55 or over - Step 2

Answer 7

CCB + ACEi or ARB or Thiazide Like Diuretic

Question 8

HTN + Black African or African-Caribbean Family Origin (Any Age) - Step 1

Answer 8

CCB

Question 9

HTN + Black African or African-Caribbean Family Origin (Any Age) - Step 2

Answer 9

CCB + ACEi or ARB or Thiazide Like Diuretic

Question 10

All HTN - Step 3

Answer 10

ACEi or ARB + CCB + Thiazide Like Diuretic