What are the key pharmacological treatments for managing hypertension in adults, according to current UK guidelines?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Offer a generic angiotensin-converting enzyme (ACE) inhibitor or angiotensin-II receptor antagonist (AIIRA) to all adults (of any age or ethnic origin) for hypertension management .

For adults of black African or African-Caribbean origin, consider an AIIRA in preference to an ACE inhibitor .

If an ACE inhibitor is not tolerated, offer an AIIRA .

Do not combine an ACE inhibitor with an AIIRA to treat hypertension .

Offer a calcium-channel blocker (CCB) or thiazide-like diuretic in addition to an ACE inhibitor or AIIRA if hypertension is not controlled by monotherapy .

Offer a combination of an ACE inhibitor or AIIRA, a CCB, and a thiazide-like diuretic if hypertension remains uncontrolled .

If hypertension is not controlled with optimal tolerated doses of an ACE inhibitor or AIIRA, plus a CCB and a thiazide-like diuretic, consider adding a fourth antihypertensive drug or seek specialist advice for resistant hypertension .

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