Hypertension Year 1

Question 1

Hyp with Type 2 DM

Or <55yrs and not black African/Caribbean origin

Step 1 NICE

Answer 1

ACEi or ARB eg

Question 2

HYP with Type 2 DM Step 2

Answer 2

To ACEi or ARB

ADD CCB or thiazide-like diuretic

Question 3

HYP with Type 2 DM

step 3

Answer 3

ACEi or ARB + CCB + thiazide-like diuretic

Question 4

Hyp with Type 2 DM

Step 4

Answer 4

Confirm resistant HYP: confirm elevated BP with ABPM/Ambulatory Blood Pressure Monitoring or Home Blood Pressure Monitoring

Check for postural hypertension and discuss adherence.

Advice or adding:

• low dose spironolactone if blood potassium level is =/<4.5mmol/l
• alpha-blocker or beta-blocker if >4.5mmol/l

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

Question 5

Hype w/o type 2 DM

Age <55 + not black African/Caribbean family origin

Answer 5

Same as steps in HYP with Type 2 DM

Question 6

HYP w/o type 2 DM

Age 55 or over

Black African/Caribbean family origin

Step 1

Answer 6

CCB

Question 7

HYP w/o type 2 DM

Age 55 or over

Black African/Caribbean family origin

Step 2

Answer 7

CCB + ACEi or ARB or thiazide-like diuretic

Question 8

HYP w/o type 2 DM

Age 55 or over

Black African/Caribbean family origin

Step 3

Answer 8

ACEi or ARB

+ CCB

+. Thiazide-like diuretic

Question 9

HYP w/o type 2 DM

Age 55 or over

Black African/Caribbean family origin

Step 4

Answer 9

Confirm resistant HYP: confirm elevated BP with ABPM/Ambulatory Blood Pressure Monitoring or Home Blood Pressure Monitoring

Check for postural hypertension and discuss adherence.

Advice or adding:

• low dose spironolactone if blood potassium level is =/<4.5mmol/l
• alpha-blocker or beta-blocker if >4.5mmol/l

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

Question 10

Coughing due to ACEi

Answer 10

Consider change to ARB if ACEI cause and unable to tolerate (e.g. Candesartan, Losartan, Valsartan + details of dose)