Hypertension in a Black African Man: First-Line Therapy

Patient B-217 is a 55-year-old Black African man who has been referred to the hypertension clinic with newly diagnosed stage 2 hypertension. He reports mild, occasional morning headaches for the past three months. He has no medical history of note and takes no regular medication. He has no known drug allergies. He does not smoke and drinks 1 unit of alcohol daily. His weight is 80 kg. On examination, blood pressure is 168/102 mmHg in both arms, measured twice 5 minutes apart. Pulse is 78 beats per minute and regular. Heart sounds are normal, no murmurs. Lungs are clear to auscultation. There is no peripheral oedema. Laboratory investigations: serum creatinine 1.0 mg/dL, eGFR 84 mL/min/1.73m², serum potassium 4.2 mmol/L, sodium 141 mmol/L, haemoglobin 14.5 g/dL, random glucose 5.2 mmol/L, and a lipid profile within normal limits. Urinalysis shows no protein or blood. ECG demonstrates sinus rhythm with left ventricular hypertrophy. He has no signs of target organ damage. The clinic doctor asks you to prescribe appropriate antihypertensive therapy for this patient, specifying the drug, starting dose, and monitoring plan.