Sample Question – CVS- 2

A 53-year-old Afro-Caribbean gentleman is diagnosed with hypertension after having three blood pressure measurements greater than 160/100 mmHg. Past medical history is not significant. His BMI is 23, and he looks well. According to the NICE guidelines, which of the following is the most appropriate to prescribe first line for this patient?

(Please select the best option)

  1. Amlodipine Correct
  2. Atenolol
  3. Diltiazem
  4. Ramipril
  5. Valsartan

Patients of African origin are more likely to have low renin hypertension. This means that they are more likely to respond to initial therapy with either a calcium antagonist or diuretic, usually a thiazide. A number of studies have shown that amlodipine is more effective in reducing systolic and diastolic blood pressures

In contrast those patients of Caucasian origin who tend to have higher levels of renin respond much more readily to angiotensin-converting enzyme (ACE) inhibition, or if they fail to tolerate an ACE inhibitor because of cough, to an angiotensin receptor blocker. For these patients, ACE inhibition is seen by NICE as the first line treatment.

ACE inhibitor and calcium antagonist combination has been the one preferred by many clinicians.


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