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Hypertension first-line treatment — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsHypertension first-line treatmentGPhC CRA

A 46-year-old man of black African family origin has clinic BP 164/98 mmHg and daytime ABPM average 158/96 mmHg. He has no diabetes, eGFR 80 mL/min/1.73 m² and potassium 4.3 mmol/L. What is the most appropriate alternative?

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Correct answer: B — Amlodipine as first-line antihypertensive treatment

In adults of black African or African-Caribbean family origin without diabetes, a calcium-channel blocker is generally first-line for hypertension. The ABPM confirms stage 2 hypertension requiring drug treatment alongside lifestyle advice. ACE inhibitors are less preferred as initial monotherapy in this group unless other indications exist. Spironolactone is usually reserved for resistant hypertension after assessment.

Reference: NICE CKS; BNF