Essential Hypertension
The patient returns over time. Make your treatment decision before revealing each prescription.
Visit 1 — First OPD Consultation
52-year-old man. Repeated clinic BP 154/96 and 150/94 mmHg; no acute symptoms.
What will you prescribe now?
Treatment decision
Start amlodipine 5 mg once daily. Ask for home BP readings. Lifestyle modification: reduce salt, avoid tobacco, moderate alcohol, lose excess weight and perform regular aerobic exercise.
Start amlodipine 5 mg once daily. Ask for home BP readings. Lifestyle modification: reduce salt, avoid tobacco, moderate alcohol, lose excess weight and perform regular aerobic exercise.
Visit 2 — Treatment Review
Six weeks later average home BP is 146/90; ankle oedema is absent.
What will you prescribe now?
Treatment decision
Continue amlodipine 5 mg and add telmisartan 40 mg once daily; check creatinine and potassium after initiation/titration.
Continue amlodipine 5 mg and add telmisartan 40 mg once daily; check creatinine and potassium after initiation/titration.
Visit 3 — Subsequent Decision
Eight weeks later BP averages 138/86 but remains above his agreed target.
What will you prescribe now?
Treatment decision
Use a single-pill combination if available and titrate telmisartan/amlodipine; if still uncontrolled, add a thiazide-like diuretic such as chlorthalidone 12.5 mg daily, with electrolytes/renal function monitored.
Use a single-pill combination if available and titrate telmisartan/amlodipine; if still uncontrolled, add a thiazide-like diuretic such as chlorthalidone 12.5 mg daily, with electrolytes/renal function monitored.
Educational use only: Synthetic cases for clinician learning. Drug selection, dose and escalation must be individualized to the actual patient, pregnancy status, age, renal/hepatic function, interactions, contraindications, affordability, local resistance/protocols and current authoritative guidance.