Hypertension — UKMLA MCQ

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EasyCardiology & Cardiovascular diseaseHypertensionUKMLA

A 55-year-old male presents with persistent BP readings averaging 150/95 mmHg. He has no end-organ damage. According to NICE guidelines what is the most appropriate first-line antihypertensive for a non-black patient under 55 years old with no diabetes?

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Correct answer: A — ACE inhibitor e.g. ramipril

NICE uses the A/C/D algorithm for step 1 treatment of uncomplicated primary hypertension. For a non-Black adult aged under 55 years with no diabetes, the first-line choice is an ACE inhibitor, such as ramipril; an ARB is used if an ACE inhibitor is not tolerated. Calcium-channel blockers are first-line for adults aged 55 or over, or for Black African/African-Caribbean adults without type 2 diabetes. Thiazide-like diuretics are alternatives or add-on therapy, and beta-blockers/alpha-blockers are not routine first-line choices. Therefore the correct answer is ACE inhibitor e.g. ramipril.

Reference: NICE guideline NG136: Hypertension in adults: diagnosis and management, last updated 26 February 2026, recommendations 1.4.32–1.4.35. https://www.nice.org.uk/guidance/ng136/chapter/Recommendations