Treating high blood pressure: which drug first, and what comes next?
One drug at a time, each at its best tolerated dose before the next is added. The first choice depends on diabetes, age and family origin.
Select any card for the reasoning, what to watch for and an exam tip.
Before any drug
Step by step
Step 1
Not at target? Titrate the dose and check adherence, then add a second drug
Step 2
Not at target? Add the third drug
Step 3
Still not at target? Confirm with home or ambulatory readings, check for postural hypotension, and ask about adherence
Step 4
Interactions and cautions to know
Key takeaway
Type 2 diabetes, or under 55 and not Black African or African-Caribbean: an ACE inhibitor or ARB first. Otherwise — 55 or over, or Black African or African-Caribbean, without diabetes — a CCB first. Both tracks meet at A + C + D.
Members’ explainer
Open this explainer with Pro or Saver
All 44 visual explainers come with membership, along with every clinical question, the EMQs and the mock exams.
