Clinical reference

Hypertension (essential, adult)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

DailyMed Amlodipine Besylate Tablet Package Insert, SetID 8a5d3f8a-4933-4f96-a193-4a7b7a607371 · DailyMed Enalapril Maleate Tablet Package Insert, SetID 5c5ef9e5-9d32-47ab-9d8a-6b4507000d66 · DailyMed Hydrochlorothiazide Tablet Package Insert, SetID 6d5e12f4-8a4b-4b1a-89bc-993d56781200 · Egyptian National Drug Formulary - Cardiovascular 2024 (bisoprolol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph) · WHO Guideline for Pharmacological Treatment of Hypertension 2021

Verified against5 documents

DailyMed Amlodipine Besylate Tablet Package Insert, SetID 8a5d3f8a-4933-4f96-a193-4a7b7a607371
DailyMed Enalapril Maleate Tablet Package Insert, SetID 5c5ef9e5-9d32-47ab-9d8a-6b4507000d66
DailyMed Hydrochlorothiazide Tablet Package Insert, SetID 6d5e12f4-8a4b-4b1a-89bc-993d56781200
Egyptian National Drug Formulary - Cardiovascular 2024 (bisoprolol monograph)
Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

Nearly always silent and found by chance when the blood pressure is measured
A few present already damaged: stroke-like symptoms or encephalopathy, chest pain, breathlessness, or sudden fluid on the lungs [breathlessness · chest pain]

Signs — what you find (9)

Examination is often unrewarding apart from the raised reading itself and sometimes swollen ankles [leg swelling]
Coarctation: delay between the two radial pulses or radial and femoral, or a gap over 20 mm Hg between arms or between arm and leg
Aortic valve disease: an ejection systolic murmur with a fourth heart sound [heart murmur]
A bruit over the kidney or carotid suggests renovascular disease or fibromuscular dysplasia [bruit]
Both kidneys palpably enlarged suggests polycystic kidney disease
Thin skin, easy bruising and high blood sugar suggest excess cortisol [bruising · hyperglycaemia]
A thyroid that is palpable, tender or enlarged points to thyroid disease, another treatable secondary cause
A fourth heart sound means a stiff left ventricle, hinting at hypertrophy and diastolic dysfunction
Crackles in the lungs or swollen legs suggest the heart is failing and that the pressure has been high a long time [crackles · leg swelling]

Tests (10)

The ACC asks for at least two office readings on at least two separate visits before diagnosing
The ESC and ESH ask for three readings 1 to 2 minutes apart, more only if the first two differ by 10 mm Hg or more, and record the average of the last two
Sit the patient quietly for 5 minutes first, and use a cuff covering 80% of the arm, since the wrong size reads too high or too low
Ambulatory monitoring is the most accurate way to diagnose it, and it exposes masked hypertension and the white coat effect
A 12-lead ECG documents left ventricular hypertrophy along with rate and rhythm
Look in the fundus for retinopathy or maculopathy
Bloods: full blood count, ESR, creatinine and eGFR, electrolytes, HbA1c, thyroid profile, cholesterol and uric acid
Urine albumin to creatinine ratio
Ankle-brachial pressure index where symptoms suggest peripheral arterial disease
Where feasible, carotid Doppler, echocardiography and brain imaging

If not this — what else fits (6)

Always consider a secondary cause, particularly in the very young or the elderly
Hyperaldosteronism
Coarctation of the aorta
Renal artery stenosis
Chronic kidney disease
Aortic valve disease

SourceStatPearls "Essential Hypertension" - disease-level clinical article

Presentation findings are traced to the source above.

BLOOD PRESSURE - choose one

AMLODIPINE

Blood pressure

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

5 mg once daily, may increase to maximum 10 mg once daily - long-term

Paediatric dose

Not first-line in children; specialist referral

Choice

Alternatives, all first-line. WHO 2021 names calcium-channel blockers, ACE inhibitors and ARBs together as first-line; amlodipine needs no electrolyte monitoring, which suits a first prescription.

Dose source

DailyMed Amlodipine Besylate Tablet Package Insert, SetID 8a5d3f8a-4933-4f96-a193-4a7b7a607371

Why

Dihydropyridine calcium-channel blocker that relaxes vascular smooth muscle to lower blood pressure; a first-line option for essential hypertension.

Cautions

Ankle oedema is dose-related and common.
Avoid in severe aortic stenosis.
Caution in hepatic impairment.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CORONAVINE 5 MG 10 TAB.	PHAROPHARMA	6.00 EGP (0.60/unit)
WINDIPINE 5 MG 30 TAB.	SANOFI	21.00 EGP (0.70/unit)
VASOPINE 5 MG 30 TABS.	ARAB DRUG COMPANY (ADCO)	24.00 EGP (0.80/unit)
AMILO 5 MG 30 TAB.	ALFACURE PHARMACEUTICALS	54.00 EGP (1.80/unit)
AMLODIPINE 5 MG 30 TAB.	AMRIYA	60.00 EGP (2.00/unit)
MYODURA 5 MG 30 TAB.	GLOBAL NAPI PHARMACEUTICALS > WOCKHARDT	69.00 EGP (2.30/unit)
NORVASC 5MG 10 TAB.	PFIZER > VIATRIS EGYPT	54.00 EGP (5.40/unit)
NORVASC 5MG 30 TAB.	PFIZER > VIATRIS EGYPT	162.00 EGP (5.40/unit)

ENALAPRIL

Blood pressure

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

5 mg once daily initially, titrate to 10-20 mg once daily (maximum 40 mg daily) - long-term

Paediatric dose

Specialist use only in children

Dose source

DailyMed Enalapril Maleate Tablet Package Insert, SetID 5c5ef9e5-9d32-47ab-9d8a-6b4507000d66

Why

ACE inhibitor that lowers blood pressure by reducing angiotensin II formation and vasoconstriction; a first-line alternative to amlodipine, avoided in pregnancy and bilateral renal artery stenosis.

Cautions

CONTRAINDICATED in pregnancy.
Avoid in bilateral renal artery stenosis.
Check creatinine and potassium 1-2 weeks after starting.
Dry cough is a common reason for switching.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PRES 10MG 30 TAB.	GLOBAL NAPI PHARMACEUTICALS	20.25 EGP (0.68/unit)
PRESSLIGHT 10 MG 10 TAB.	EL-OBOUR	10.00 EGP (1.00/unit)
EZAPRIL 10 MG 30 TABS.	MULTI-APEX	54.00 EGP (1.80/unit)

LOSARTAN

Blood pressure

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

25-50 mg once daily, titrated after several weeks to 100 mg/day in 1-2 divided doses - long-term

Paediatric dose

(Licensed for hypertension from 6 years, weight-banded: 20 to under 50 kg, 25 mg once daily, maximum 50 mg/day; 50 kg and over, 50 mg once daily, maximum 100 mg/day. Not recommended if creatinine clearance is below 30 mL/min/1.73 m2. Paediatric hypertension is a specialist referral.)

Dose by age
6 years and over:	By weight. 20 to under 50 kg: 25 mg once daily, maximum 50 mg a day. 50 kg and over: 50 mg once daily, maximum 100 mg a day. Not if creatinine clearance is below 30 mL/min/1.73 m2. Specialist referral.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph)

Why

WHO 2021 gives a strong, high-certainty recommendation naming ACE inhibitors and ARBs together as one of three first-line classes, and losartan is on the Egyptian EML 2025 under antihypertensive medicines. The commonest reason for switching is the ACE inhibitor cough, already listed as a caution on the enalapril row.

Cautions

CONTRAINDICATED in pregnancy.
Does not cause the dry cough - this is the switch when enalapril is not tolerated. Do not give both.
Check creatinine and potassium 1-2 weeks after starting and after each increase.
Avoid in bilateral renal artery stenosis; do not combine with aliskiren in diabetes or renal impairment.
Start at 25 mg in patients over 75 and in hepatic impairment.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
LOSAPOTT 50 MG 14 F.C. TAB.	PHAROPHARMA	21.60 EGP (1.54/unit)
LOSTAPRESSIN 50 MG 21 F.C. TABS.	DELTA PHARMA	33.00 EGP (1.57/unit)
AMOSAR 50MG 30 F.C. TABS.	AMOUN	51.00 EGP (1.70/unit)
LOSARTAN-AMRIYA 50MG 10 TAB.	AMRIYA	21.60 EGP (2.16/unit)
LOSARMEPHA-50 MG 14 F.C. TABS.	SIGMA > ACINO	32.40 EGP (2.31/unit)
LOZAPRESS 50MG 14 F.C. TAB.	SIGMA	32.40 EGP (2.31/unit)
LOSAR 50MG 28 F.C. TAB.	UNIPHARMA	82.00 EGP (2.93/unit)
COZAAR 50MG 14 TAB.	MERCK SHARP & DOHME	74.50 EGP (5.32/unit)

HYDROCHLOROTHIAZIDE

Blood pressure

2nd line

Strength25 mg

Formoral.solid

Adult dose and duration

25 mg daily given as a single dose, may be increased to 50 mg daily - long-term

Paediatric dose

Specialist use only in children

Dose source

DailyMed Hydrochlorothiazide Tablet Package Insert, SetID 6d5e12f4-8a4b-4b1a-89bc-993d56781200

Why

Thiazide diuretic that lowers blood pressure by reducing sodium and water reabsorption in the distal tubule; added as a second-line agent when a single first-line drug does not achieve control.

Cautions

Monitor potassium and sodium.
May precipitate gout.
Caution in diabetes - may raise blood glucose.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HYDROZIDE 25 MG 30 SCORED TABS.	EPCI	8.00 EGP

BISOPROLOL

Blood pressure

3rd line

Strength5 mg

Formoral.solid

Adult dose and duration

2.5-5 mg once daily, up to 10 mg - long-term

Paediatric dose

Not routinely used in children

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (bisoprolol monograph)

Why

Cardioselective beta-blocker that lowers blood pressure and heart rate by blocking beta-1 adrenergic receptors; a third-line option when blood pressure remains uncontrolled on first- and second-line agents, avoided in asthma and high-grade heart block.

Cautions

Avoid in asthma and in second/third-degree heart block.
Do not stop abruptly - risk of rebound.
May mask hypoglycaemia in diabetes.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
BISOPROL 5 MG 20 F.C. TAB.	BIOPHARM EGYPT	9.00 EGP (0.45/unit)
CAPROL 5MG 30 F.C.TAB.	INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA	18.00 EGP (0.60/unit)
BISOBETA 5MG 20 F.C. TAB.	MEMPHIS	14.00 EGP (0.70/unit)
SOPROL 5MG 20 F.C.TAB.	EVA PHARMA	14.00 EGP (0.70/unit)
NORMOCARD 5 MG 30 TAB.	PHARMA CURE	54.00 EGP (1.80/unit)
BISOLOCK 5 MG 30 F.C.TABS.	PHARCO	57.00 EGP (1.90/unit)
EGYPRO 5 MG 30 TAB.	EGPI > ABBOTT	63.00 EGP (2.10/unit)
CONCOR 5 MG 30 F.C. TABS.	AMOUN > MERCK KGAA F.R.GERMANY	72.00 EGP (2.40/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.