Step 1 | ACEi or ARB |
---|---|
Step 2 | ACEi or ARB plus CCB or thiazide like diuretic |
Step 3 | ACEi or ARB plus CCB plus thiazide like diuretic |
Step 4 | confirm resistant HTN with ambulatory monitoring *compliance check *postural hypotension check *Consider: spironolactone (K≤4.5) *Consider: ∝blocker (K>4.5) |
Step 1 | ACEi or ARB |
---|---|
Step 2 | ACEi or ARB plus CCB or thiazide like diuretic |
Step 3 | ACEi or ARB plus CCB plus thiazide like diuretic |
Step 4 | confirm resistant HTN with ambulatory monitoring *compliance check *postural hypotension check *Consider: spironolactone (K≤4.5) *Consider: ∝blocker (K>4.5) |
Step 1 | CCB |
---|---|
Step 2 | CCB plus ACEi or ARB or thiazide like diuretic |
Step 3 | CCB plus ACEi or ARB plus thiazide like diuretic |
Step 4 | confirm resistant HTN with ambulatory monitoring *compliance check *postural hypotension check *Consider: spironolactone (K≤4.5) *Consider: ∝blocker (K>4.5) |
Step 1 | CCB |
---|---|
Step 2 | CCB plus ARB or thiazide like diuretic |
Step 3 | CCB plus ARB plus thiazide like diuretic |
Step 4 | confirm resistant HTN with ambulatory monitoring *compliance check *postural hypotension check *Consider: spironolactone (K≤4.5) *Consider: ∝blocker (K>4.5) |
Angiotensin-converting enzyme (ACE) inhibitors generally NOT for Afro-Caribbean |
|||
---|---|---|---|
initial | usual | max | |
Lisinopril | 10mg OD | 20mg OD | 80mg OD |
Perindopril | check formulation | ||
Enalapril (Vasotec) | 5mg OD | 20mg OD | 40mg OD |
Ramipril (Altace) | 1.25–2.5 mg OD | 10mg OD |
Angiotensin receptor blockers (ARB) NICE | |
---|---|
ARB | dose (increase per 4/52) |
Losartan | 50mg to 100mg OD >75yo: start 25mg |
Irbesartan | 150mg to 300mg OD >75yo: start 75-150mg |
Olmesartan | 10mg to 20mg OD (max. 40mg) |
Valsartan | 80mg to 320mg OD |
Candesartan | 8mg to 32mg OD |
Calcium channel blockers (CCB) NICE | |||
---|---|---|---|
dihydropyridines | |||
CCB | Initial | Maintenance | Max |
Amlodipine | 5mg OD | 5-10mg OD | 10mg OD |
Felodipine | 5mg OD* | 5-10 OD | 20mg OD |
Lacidipine | 2mg OD | 2-6mg OD | 6mg OD |
Lercanidipine | 10mg OD | 10-20mg OD | 20mg OD |
Nicardipine | 20mg tds | 20-40mg tds | 40mg tds |
Nifedipine | 20-30mg OD | 30-90mg OD | 90mg OD |
Thiazide like diureticsBNF | |
---|---|
Dose | |
Chlortalidone | 25mOD to 50mg |
Indapamide | 2.5mg OD |
Metolazone | 5mg OD then alternate days maintenance |
Xipamide | 20mg OD |