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First-line treatment for hypertension in a 58-year-old with type 2 diabetes?

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3 cited · 9 sources found

Hypertension with type 2 diabetes

For a 58-year-old with type 2 diabetes, offer an ACE inhibitor or an ARB as step 1, whatever their family origin.1

Starting treatment

Start ramipril 2.5 mg once daily and titrate every 2 to 4 weeks. If it causes a cough, switch to an ARB such as losartan 50 mg.2

Step 2 and beyond

Add amlodipine 5 mg or indapamide 2.5 mg. At step 3, combine all three classes before spironolactone.1

Key points

ACE inhibitor or ARB first, whatever their age or family origin.1
Aim for a clinic BP below 140/90 mmHg if under 80.1
Check U&Es and eGFR before starting and after each dose change.2

When to refer

Same day if clinic BP is 180/120 mmHg or higher with retinal haemorrhage or papilloedema.1

How it works

From question to cited answer in three steps.

Step 1
We find the right pages
We search the guideline library, or trusted websites, for the pages that deal with your question.
NICE NG136: Hypertension
NICE NG28: Type 2 diabetes
NHS: Ramipril
Step 2
We keep what matters
Anything that does not really answer your question is set aside, so only the useful sources are used.
NICE NG136: HypertensionKept
Hypertension in pregnancySet aside
NICE NG28: Type 2 diabetesKept
Step 3
You get a clear answer
The key points come first, each linked to where it came from, so you can check it yourself in seconds.
Key points
Offer an ACE inhibitor or ARB first 1
Aim for a clinic BP below 140/90 2

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Clinical guideline · Ulcerative colitis · Management

Managing a flare-up

Arrange emergency admission if a severe flare-up is suspected. Features of a severe flare include:
- Frequent bloody or night-time diarrhoea.
- Fever, dehydration, a fast pulse or low blood pressure.
- Severe abdominal pain or a suspected obstruction.
If admission is not needed:
- Look for another cause of the symptoms, such as Clostridioides difficile infection.
- Check how well the person is taking their current treatment.
- Ask for an urgent specialist review.

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Gout flare on ramipril, what can I give?

Offer colchicine or an NSAID with PPI cover, guided by renal function 1

Consider a short oral steroid course if both are contraindicated 2

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NICE NG219Reliable

NHS: GoutReliable

patient.infoStandard

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Act nowBloody diarrhoea more than 6 times a dayTemperature above 37.8°C

Guideline library

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Local AF anticoagulation pathway.pdfCardiology

Sepsis screening protocol 2026.pdfPractice

Paediatric fever traffic light.pdfPaediatrics

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Gout flare on ramipril2m

UC flare, when to admit1h

Statin choice in CKD 3Yesterday

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