Pharmacotherapy

NICE Recommends:

• lowering the threshold for treating stage 1 hypertension in patients < 80 years from 20% to 10%
• angiotensin receptor blockers can be used instead of ACE-inhibitors where indicated
• if a patient is already taking an ACE-inhibitor or angiotensin receptor blocker, then a calcium channel blocker OR a thiazide-like diuretic can be used. Previously only a calcium channel blocker was recommended

Flow chart showing the management of hypertension as per current NICE guideliness

Step 1 treatment

• patients < 55-years-old or a background of type 2 diabetes mellitus: ACE inhibitor or a Angiotensin receptor blocker (ACE-i or ARB): (A)
  • angiotensin receptor blockers should be used where ACE inhibitors are not tolerated (e.g. due to a cough)
• patients >= 55-years-old or of black African or African-Caribbean origin: Calcium channel blocker (C)
  • ACE inhibitors have reduced efficacy in patients of black African or African-Caribbean origin are therefore not used first-line

Step 2 treatment

• if already taking an ACE-i or ARB add a Calcium channel blocker or a thiazide-like Diuretic
• if already taking a Calcium channel blocker add an ACE-i or ARB or a thiazide-like Diuretic
  • for patients of black African or African-Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider an angiotensin receptor blocker in preference to an ACE inhibitor
• (A + C) or (A + D) or (C + A) or (C + D)

Step 3 treatment

• add a third drug to make, i.e.:
  • if already taking an (A + C) then add a D
  • if already (A + D) then add a C
• (A + C + D)

Step 4 treatment