ABSTRACT
Non-Afro-Caribbean individuals under 55 years of age should be initially treated with either A or B, i.e. ACE inhibitors or β-blockers, because these drugs are better at reducing renin-dependent hypertension, which is often seen in this cohort of individuals. Afro-Caribbean and older patients (>55 years) should be started on either C or D, i.e. calcium channel blockers or diuretics. If a single agent is ineffective, a second agent from the opposite group should be added, i.e. if A or B does not work, either C or D should be added. For example, a 50-year-old white man whose hypertension was not controlled with an ACE
4. B – Admit to hospital for oral antihypertensive medication This is a case of malignant hypertension, which can be defined as a systolic blood pressure greater than 200 mmHg and/or a diastolic pressure greater than 120 mmHg in association with severe retinopathy (grade III-IV). Patients are often symptomatic and complain of headache, blurred vision and dizziness. This is a serious condition, and if left untreated the mortality rate is approximately 90% after 1 year. In the absence of papilloedema, congestive heart failure and neurological complications such as encephalopathy and seizure, it is usual to treat with oral agents on a general ward. The combination of a β-blocker with a thiazide diuretic (e.g. atenolol with bendroflumethiazide) is the usual first-line treatment.
