Hypertension
The application of monotherapy, dual therapy and triple therapy options presented here should be considered in line with local/national guidance.
NICE NG136: Hypertension in adults
Monotherapy – For type 2 diabetics and those aged <55 years and not of black-African or African-Caribbean family origin.
ACE inhibitor (lisinopril or ramipril) or ARB (candesartan) if ACE inhibitor not tolerated.
Monotherapy – For age 55 years and over or black-African or African-Caribbean family origin.
Calcium channel blocker (amlodipine).
History Notes
27/05/2026
Regional formulary chapter launched.
Dual therapy – For type 2 diabetics and those aged <55 years and not of black-African or African-Caribbean family origin.
ACE inhibitor (lisinopril or ramipril) or ARB (candesartan) and either Calcium channel blocker (amlodipine) or Diuretic (indapamide or bendroflumethiazide).
Calcium channel blocker (amlodipine).
Thiazide-like diuretic (indapamide) or thiazide (bendroflumethiazide).
Dual therapy – For age 55 years and over or black-African or African-Caribbean family origin.
Calcium channel blocker (amlodipine) and either ACE inhibitor (lisinopril) or ARB (candesartan) or Diuretic (indapamide or bendroflumethiazide).
ACE inhibitor (lisinopril or ramipril) or ARB (candesartan) – consider an ARB in preference to an ACE inhibitor in adults of African and Caribbean family origin, or if an ACE inhibitor is not tolerated due to cough.
Thiazide-like diuretic (indapamide) or thiazide (bendroflumethiazide).
History Notes
27/05/2026
Regional formulary chapter launched.
Triple therapy – ACE inhibitor or ARB and Calcium channel blocker and Thiazide/Thiazide-like diuretic.
ACE inhibitor (lisinopril or ramipril) or ARB (candesartan) – consider an ARB in preference to an ACE inhibitor in adults of African and Caribbean family origin, or if an ACE inhibitor is not tolerated due to cough.
Calcium channel blocker (amlodipine).
Thiazide-like diuretic (indapamide) or thiazide (bendroflumethiazide).
History Notes
27/05/2026
Regional formulary chapter launched.
Consider specialist advice if BP is uncontrolled on optimal tolerated doses of 4 drugs.
Use low dose spironolactone if K+ ≤ 4.5 mmol/L and eGFR>60mL/min/1.73m².
Amiloride is a less cost-effective preparation compared to the combination co-amilofruse.
Doxazosin (alpha-blocker) or Bisoprolol (beta-blocker) if K+ ≥ 4.5 mmol/L.
History Notes
27/05/2026
Regional formulary chapter launched.
Caution with use of labetalol in asthmatic or diabetic patients.
Nifedipine modified-release formulations should be prescribed by brand due to differences in bio-availability.
Intravenous options for severe hypertension.
Prescribing Notes:
- Refer to local guidelines for support on the diagnosis and subsequent management of hypertension:
- See NICE NG133 Hypertension in pregnancy: diagnosis and management.
- New onset hypertension should be referred for specialist advice.
- In general, mild to moderate hypertension in pregnancy should not be treated.
- Beta-blockers may cause bronchospasm; use with caution and under specialist supervision in patients with a history of asthma.
History Notes
27/05/2026
Regional formulary chapter launched.