Initial choice of antihypertensive for Evelyn

Which class of antihypertensive is recommended for Evelyn at this stage?

Choose whether the following antihypertensives are suitable for Evelyn

1. Calcium channel blocker – Yes – A CCB is first choice for people of people aged 55 years or older, or those of black African or Caribbean descent of any age.
2. ACE inhibitor – No – An ACE inhibitor would be the first choice for someone aged less than 55 years. African-Caribbean and elderly individuals tend to have low renin hypertension and respond less well to monotherapy with an ACE inhibitor.
3. Thiazide-like diuretic – Yes – Could be used as first choice if a CCB is not appropriate (e.g. because of intolerance, oedema or risk of heart failure). Used to be considered an alternative to a CCB but there is now superior evidence for CCBs.
4. Loop diuretic – No – Loop diuretics are not routinely used for the treatment of hypertension. Thiazide diuretics have a longer antihypertensive effect than loop diuretics.
5. Beta-blocker – No – Beta-blockers are not recommended for the initial treatment of hypertension. Recent data shows that beta blocker treatment is inferior to other treatments in terms of cardiovascular protection. This, plus the increased risk of new onset diabetes, means that beta blockers are no longer first line treatment for hypertension. They are sometimes used in the treatment of ‘resistant hypertension’ (stage 4) in combination with a CCB, ACE/ARB & thiazide.
6. ARB – No – A low-cost ARB would be an alternative to an ACE inhibitor for someone aged less than 55 years. Recent studies have demonstrated equivalent clinical outcomes to ACE inhibitors.