Table 1 Recommendations for Management of Hypertension in Zimbabwe

First Line

Thiazide diuretic

• Hydrochlorothiazide

hydrochlorothiazide 12.5 – 25 mg once a day. Unwanted side effects include raised plasma glucose, uric acid, and cholesterol and reduced plasma potassium

Calcium Channel blockers

• Nifedipine

• Amlodipine

Nifedipine slow release 10- 40 mg once or twice a day or Amlodipine 5-10 mg once a day.

Second line

Angiotensin converting enzyme (ACE) inhibitors

• Enalapril

• Lisinopril

Enalapril 5-40 mg once a day or Lisinopril 5-40 mg once a day. Unwanted side effects are reported as a persistent cough that might occur in 10–25% of the patients, angioedema, and postural hypotension.

An additional warning is that all ACE inhibitors can cause excessive hypotension and renal failure is also listed. In the event of a cough developing, Angiotensin Receptors Blockers (ARBs) can be substituted for ACE inhibitors.

Hyperkalaemia can develop with the concomitant administration of ACE inhibitors with potassium supplements or potassium retaining medicines and this should only be done with careful monitoring of serum potassium.

Angiotensin receptor blockers (ARBs)

• Losartan

Losartan 25-100 mg once or twice a day.

Beta blockers

• Atenolol

Atenolol 50 mg once a day. Unwanted side effects include precipitation or exacerbation of asthma, heart failure, impaired glucose control, fatigue and peripheral vascular disease.

Alpha blockers

• Prazosin

• Doxazosin

Prazosin 0.5 – 5 mg twice or three times a day; or Doxazosin 4- 16 mg once a day.