# Hypertension (essential, adult) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Amlodipine — 5 mg — oral.solid - Enalapril — 10 mg — oral.solid - Losartan — 50 mg — oral.solid - Hydrochlorothiazide — 25 mg — oral.solid - Bisoprolol — 5 mg — oral.solid ## Complete treatment card ```text HYPERTENSION (ESSENTIAL, ADULT) 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 Review status: REVIEWED against 4 sources listed above (2026-08) 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 Source StatPearls "Essential Hypertension" - disease-level clinical article Status traced to the source above BLOOD PRESSURE - choose one 1. AMLODIPINE [1st line] Adult 5 mg once daily, may increase to maximum 10 mg once daily - long-term Peds 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. 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. Caution Ankle oedema is dose-related and common. Avoid in severe aortic stenosis. Caution in hepatic impairment. Egypt 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 COM... 24.00 EGP (0.80/unit) AMILO 5 MG 30 TAB. ALFACURE PHAR... 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 P... 69.00 EGP (2.30/unit) NORVASC 5MG 10 TAB. PFIZER > VIAT... 54.00 EGP (5.40/unit) NORVASC 5MG 30 TAB. PFIZER > VIAT... 162.00 EGP (5.40/unit) 2. ENALAPRIL [1st line] Adult 5 mg once daily initially, titrate to 10-20 mg once daily (maximum 40 mg daily) - long- term Peds Specialist use only in children 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. Caution 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. Egypt PRES 10MG 30 TAB. GLOBAL NAPI P... 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) 3. LOSARTAN [1st line] Adult 25-50 mg once daily, titrated after several weeks to 100 mg/day in 1-2 divided doses - long-term Peds 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. (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.) 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. Caution 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. Egypt 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 &... 74.50 EGP (5.32/unit) 4. HYDROCHLOROTHIAZIDE [2nd line] Adult 25 mg daily given as a single dose, may be increased to 50 mg daily - long-term Peds Specialist use only in children 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. Caution Monitor potassium and sodium. May precipitate gout. Caution in diabetes - may raise blood glucose. Egypt HYDROZIDE 25 MG 30 SCORED TABS. EPCI 8.00 EGP 5. BISOPROLOL [3rd line] Adult 2.5-5 mg once daily, up to 10 mg - long-term Peds Not routinely used in children 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. Caution Avoid in asthma and in second/third-degree heart block. Do not stop abruptly - risk of rebound. May mask hypoglycaemia in diabetes. Egypt BISOPROL 5 MG 20 F.C. TAB. BIOPHARM EGYPT 9.00 EGP (0.45/unit) CAPROL 5MG 30 F.C.TAB. INTERNATIONAL... 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... 72.00 EGP (2.40/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)