A gentleman aged 55 years old is found to have hypertension, which of the following is the best drug treatment for him to start on?

A) Nifedipine
B) Ramipril
C) Losartan
D) Doxazosin
E) Bendroflumethiazide


The answer is A.

Following NICE guidelines and this lovely looking flowchart - page 13 of this PDFhttp://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf - this gentleman should be started on a calcium channel blocker. Nifedipine is the only calcium channel blocker listed.

All of the drugs listed *could* be used for hypertension.

Ramipril is an ACE inhibitor and if the gentleman was under 55 then this would be one option for first line treatment. The other option if he was under 55 would be Losartan which is an angiotensin II receptor blocker [or ARB] - these drugs act like ACE inhibitors but do not have the associated dry cough side effect.

Doxazosin is an alpha-blocker and can be used for so called "resistant hypertension" - where a patient is already on an ACE inhibitor, a calcium channel blocker and a thiazide-like diuretic.

Bendroflumethiazide is a thiazide-like diuretic.