A 50-year-old Black African woman with newly diagnosed stage 2 hypertension has a clinic BP of 164/91 mmHg. According to NICE guidance, which is the most appropriate first-line antihypertensive treatment?

• A. Lercanidipine hydrochloride
• B. Lisinopril
• C. Bendroflumethiazide
• D. Amlodipine

Answer: (A)

In Black African patients, antihypertensive therapy is often started with a calcium channel blocker or a thiazide-like diuretic because these classes tend to give a stronger blood pressure reduction in this group when used as first-line treatment. For stage 2 hypertension, guidelines typically recommend starting two first-line medicines from different classes. Among the options, a calcium channel blocker fits this approach, and lercanidipine is one of the dihydropyridine calcium channel blockers that can be used as initial therapy. It effectively lowers BP and may have a favorable tolerability profile, which supports adherence. Lisinopril (an ACE inhibitor) is known to be less robustly effective as monotherapy in Black patients, and while a thiazide diuretic is also a valid first-line option, the calcium channel blocker choice aligns with the guidance to use a first-line agent from this class in this ethnicity. In practice, you would pair a first-line calcium channel blocker with another first-line drug from a different class to reach target BP.