Choice of antihypertensive

ACE inhibitors (e.g. enalapril,
lisinopril, perindopril, ramipril, trandolopril) inhibit the conversion of angiotensin 1 to angiotensin 2 ARBs (e.g. candesartan, losartan, irbesartan, valsartan) block the action of angiotensin 2 at the angiotensin 2 receptor. This causes causes vasodilation and subsequent reduced blood pressure. Offer people aged under 55 years step 1 antihypertensive treatment with an ACE inhibitor or a low-cost ARB.

CCB’s reduce calcium influx into vascular smooth muscle cells. This promotes vasodilation, and reduces blood pressure. Offer step 1 antihypertensive treatment with a CCB to people aged over 55 years and to black people of African or Caribbean family origin of any age. Blood pressure reduction appears to be more marked with CCBs in people with low-renin hypertension such as the elderly and those of Afro-Caribbean descent

A = ACE inhibitor or low-cost angiotensin II receptor blocker (ARB)

ACE inhibitors (e.g. enalapril,
lisinopril, perindopril, ramipril, trandolopril) inhibit the conversion of angiotensin 1 to angiotensin 2 ARBs (e.g. candesartan, losartan, irbesartan, valsartan) block the action of angiotensin 2 at the angiotensin 2 receptor. This causes causes vasodilation and subsequent reduced blood pressure. Offer people aged under 55 years step 1 antihypertensive treatment with an ACE inhibitor or a low-cost ARB

+

C = calcium channel blockers (CCBs) (e.g. amlodipine, felodipine, nifedipine, diltiazem, verapamil)

CCB’s reduce calcium influx into vascular smooth muscle cells. This promotes vasodilation, and reduces blood pressure. Offer step 1 antihypertensive treatment with a CCB to people aged over 55 years and to black people of African or Caribbean family origin of any age. Blood pressure reduction appears to be more marked with CCBs in people with low-renin hypertension such as the elderly and those of Afro-Caribbean descent

A = ACE inhibitor or low-cost angiotensin II receptor blocker (ARB)

ACE inhibitors (e.g. enalapril,
lisinopril, perindopril, ramipril, trandolopril) inhibit the conversion of angiotensin 1 to angiotensin 2 ARBs (e.g. candesartan, losartan, irbesartan, valsartan) block the action of angiotensin 2 at the angiotensin 2 receptor. This causes causes vasodilation and subsequent reduced blood pressure. Offer people aged under 55 years step 1 antihypertensive treatment with an ACE inhibitor or a low-cost ARB

+

C = calcium channel blockers (CCBs) (e.g. amlodipine, felodipine, nifedipine, diltiazem, verapamil)

CCB’s reduce calcium influx into vascular smooth muscle cells. This promotes vasodilation, and reduces blood pressure. Offer step 1 antihypertensive treatment with a CCB to people aged over 55 years and to black people of African or Caribbean family origin of any age. Blood pressure reduction appears to be more marked with CCBs in people with low-renin hypertension such as the elderly and those of Afro-Caribbean descent

+

D = thiazide-like diuretics (e.g. bendroflumethiazide, chlortalidone, indapamide)
Thiazide-like diuretics increase sodium excretion and urine volume. This results in reduced blood volume and reduced blood pressure. If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.

A + C + D consider further diuretic 3, 4 or alpha or beta-blocker 5

Consider seeking expert advice