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Hypertension first-line treatment — GPhC CRA MCQ

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HardCardiovascular TherapeuticsHypertension first-line treatmentGPhC CRA

A 58-year-old man of Black African family origin without diabetes takes amlodipine 10 mg daily. Adherence is confirmed, but home BP remains 151/94 mmHg and ankle oedema is mild. Which step-2 option is preferred if adding renin–angiotensin system treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Add losartan, preferring an ARB to an ACE inhibitor

When BP is not controlled on step-1 CCB treatment, an ACE inhibitor, ARB or thiazide-like diuretic can be added. For adults of Black African or African–Caribbean family origin, NICE specifically advises considering an ARB in preference to an ACE inhibitor. ACE inhibitor plus ARB is not used for hypertension, and immediate-release nifedipine or routine propranolol are not appropriate step-2 choices.

Reference: NICE NG136: https://www.nice.org.uk/guidance/ng136/chapter/recommendations