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First-Line Antihypertensive Under 55 NICE — ESENeph MCQ

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EasyHypertensionFirst-Line Antihypertensive Under 55 NICEESENeph

A 42-year-old man with CKD G3a develops new hypertension (BP 155/95). He has no albuminuria (uACR <3 mg/mmol). He is not diabetic. What first-line antihypertensive class does NICE NG136 recommend for a patient under 55 without albuminuria?

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Correct answer: A — ACE inhibitor or ARB

NICE NG136 (Hypertension) recommends ACEi or ARB as step 1 for patients under 55 years, regardless of albuminuria or CKD status. For patients ≥55 or of Black African/Caribbean descent, calcium channel blocker is step 1. This is a general hypertension recommendation. Separately, KDIGO 2024 CKD guideline recommends ACEi/ARB specifically when albuminuria is ≥3 mg/mmol for its proteinuria-reducing and renoprotective properties. In this patient (under 55), both guidelines converge on ACEi/ARB as first-line, though for different primary reasons.

Reference: https://guidelines.ukkidney.org