QuestionSBA
QuestionChoice
Amlodipine is a calcium-channel blocker, which is the correct drug to give to this patient for the management of his hypertension. However, it should be added to the maximum dose of an ACE inhibitor, such as ramipril 10mg OD (which he already takes).
10000627
b
Switch to 5mg amlodipine OD
QuestionChoice
Amlodipine is a calcium-channel blocker, which is the second step in the hypertension treatment pathway once the first step drug is at the maximum dose. It should be added to the patients existing medication, which in this case is 10mg Ramipril.
10000626
a
Add amlodipine 5mg OD
QuestionChoice
Indapamide is a thiazide-like diuretic, which is used as the third step in the treatment of hypertension - E.g. if a patient is still hypertensive despite both an ACE inhibitor (e.g. ramipril) and a calcium channel blocker (e.g. amlodipine). In this case, the patient would continue taking their ramipril, whilst being prescribed a calcium channel blocker for a number of weeks/months before a thiazide-like diuretic would be considered.
10000629
d
Add Indapamide 2.5mg OD
QuestionChoice
Bisoprolol is a beta-blocker, which may be used to treat hypertension. However, it does not form part of the usual NICE guidelines for hypertension management, and is usually only considered in patients with raised serum potassium (>4.5mmol/) - which this patient history does not mention. Therefore, following the stepwise approach of hypertension management would lead us to prescribe a calcium-channel blocker e.g. amlodipine for this patient to take as well as his regular ACE inhibitor (ramipril).
10000630
e
Bisoprolol 10mg OD
QuestionChoice
Amlodipine is a calcium-channel blocker, which is the correct drug to add to this patient's existing maximum-dose ACE inhibitor (ramipril). However, indapamide is a thiazide-like diuretic and is the third step in managing hypertension, so would not be added to this patient's regime until he was established on a both maximum dose ACE inhibitor and calcium channel blocker, and had tried alternative drugs within those classes, whilst still having uncontrolled hypertension.
10000628
c
Add amlodipine 5mg OD + indapamide 2.5mg OD
Concept
Chapter
2693
3701
Hypertension
Topic
134
Cardiology
12672
A 42-year-old caucasian male has a clinic blood pressure reading of 144/98 despite treatment with 10mg Ramipril OD for the past six months.

Which of the following is the most appropriate next step in the management of this patient?
a