Hypertension

Prescribing guidelines

You are a GP pharmacist prescriber.

Mr David Collins, date of birth 14th March 1967, attends for a blood pressure review at his GP surgery. He has been monitoring his blood pressure at home for the past two weeks using an NHS-approved upper arm device. The table below shows his readings for the last week: 

He reports no chest pain, no shortness of breath, no headaches, no visual disturbance, no neurological symptoms, no ankle swelling, and no episodes of syncope. He denies any symptoms suggestive of secondary causes of hypertension, such as palpitations, heat intolerance, sweating, nocturia or muscle weakness. He has not experienced any postural dizziness.

Past medical history: None
Drug history: None
Allergies: No known drug allergies
Social history: Smokes 10 cigarettes per day, drinks approximately 6–8 units per week. No recreational drug use. Works as a lorry driver.
Family history: Father had hypertension diagnosed in his 60s. No premature cardiac disease.
Recent investigations: Urea & electrolytes normal, eGFR 93. No proteinuria on dipstick.
Lifestyle factors: BMI 28. No regular exercise.
Ethnicity: White British

Address: 22 Willowbank Rise, WB4 8LP, England
NHS number: 492 668 1039

You may indicate where you would record any additional information not included in the brief.

Your task is to prescribe the most appropriate first-line antihypertensive for this patient in accordance with national guidelines.

1. NICENational Institute for Health and Care Excellence (2019) Hypertension in adults: diagnosis and management (NG136). Available at: https://www.nice.org.uk/guidance/ng136/chapter/Recommendations (Accessed: 30 November 2025).
2. BNF – AmlodipineBritish National Formulary (2025) Amlodipine. Available at: https://bnf.nice.org.uk/medicinal-forms/amlodipine.html (Accessed: 30 November 2025).