Step wise treatment for hypertension according to NICE guidelines

Question 1

35 y/o male has blood pressure of 160/90mm/Hg. He is of afro-carribean descent and doesn’t have diabetes or any other medical conditions. He is already taking amlodipine. What do you prescribe?

Answer 1

Ramipril, if not tolerated due to cough give him losartan.

Question 2

58 year old lady with hypertension needs medication. No other medical history of note. What do you prescribe?

Answer 2

Amlodipine

Question 3

68 year old Jamaican patient with T2 diabetes comes to GP who needs his blood pressure to be controlled with medication. What do you give?

Answer 3

ACEi e.g. ramipril

Question 4

78 year old lady who is not caucasian has bp of 170/89mmHg. What do you give her?

Answer 4

Amlodipine

Question 5

Patient takes Amlodipine, Candesartan and still has resistant hypertension. What could you prescribe her?

Answer 5

Bendroflumethazide

Question 6

If steps 1-3 do not control the hypertension of a patient, what are the next steps?

Answer 6

1. confirm adherence of patient and their medication
2. confirm that patient doesn’t have postural hypotension by taking the lying and standing BP
3. prescribe low does spironolactone providing the potassium is lower than 4.5
4. prescribe an alpha blocker such as doxasozin