hypertension
with Type2 diabetes
| 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) |
not Type2 diabetes, <55yo, not Afro-Caribbean
| 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) |
not Type2 diabetes, 55(+)yo
| 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) |
not Type2 diabetes, Afro-Caribbean
| 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 |
author Dr Dylan Jenkins Aug 23
ref. NICE