Why a calcium-channel blocker first for Black African or African-Caribbean patients?
On average, their high blood pressure depends less on the renin–angiotensin system — so the drugs that block it do less on their own.
Select any card for the reasoning, what to watch for and an exam tip.
The puzzle
Two 45-year-olds have newly confirmed stage 1 hypertension, and neither has diabetes. One is of white British family origin, the other of African-Caribbean family origin. NICE starts them on different drugs. Why?
The answer, step by step
Who is most at risk
- Adults of Black African or African-Caribbean family origin: hypertension is more common.
- Black patients on an ACE inhibitor: angioedema is more common.
What to do
Key takeaway
Without type 2 diabetes, NICE starts with a CCB at any age. When an ACE inhibitor or ARB is added, choose the ARB.