PSA Hypertension Guide: Simple One-Liners
Hypertension is one of the most frequently assessed topics in the PSA. The good news...? Most questions focus on a small number of prescribing principles that can be revised quickly and applied confidently in practice. Take a look at the following:
First-Line Treatment
✅ Under 55 years (including most Asian patients) → ACE inhibitor (e.g. ramipril)
✅ 55 years and over → Amlodipine
✅ Black African or African-Caribbean family origin → Amlodipine first-line
Treatment Escalation
✅ Step 2 → ACE inhibitor/ARB + calcium channel blocker
✅ Step 3 → ACE inhibitor/ARB + calcium channel blocker + thiazide-like diuretic (usually indapamide)
✅ Resistant hypertension → Consider spironolactone
Spironolactone Safety
✅ Check potassium before prescribing
✅ K⁺ ≤4.5 mmol/L → Spironolactone may be appropriate
✅ Raised potassium? → Consider alternatives such as doxazosin or bisoprolol
ACE Inhibitor Essentials
✅ Starting ramipril? Check U&Es within 1-2 weeks
✅ ACE inhibitor cough? Switch to an ARB such as losartan
✅ Monitor for hyperkalaemia and deteriorating renal function
Pregnancy
✅ Hypertension in pregnancy? Think labetalol
❌ Avoid ACE inhibitors and ARBs
Common Drug Interaction
❌ Ramipril + ibuprofen = increased risk of acute kidney injury
✅ Always ask about over-the-counter medicines
Hyperkalaemia
Renal function
ACE inhibitor monitoring
Resistant hypertension
Pregnancy
NSAID interactions
The 5-Second PSA Checklist
Before choosing an answer, ask yourself:
✅ How old is the patient?
✅ Is ethnicity relevant?
✅ What is the potassium?
✅ What is the renal function?
✅ What medicines are already prescribed?
✅ Is the patient pregnant?
Master these checks and you'll answer the majority of PSA hypertension questions safely, confidently and efficiently.
Looking for more PSA-style questions, model answers and examiner guidance? Explore the Pharmascholar PSA Revision Series and speak online with Dr Mike Davies to strengthen your prescribing decision-making before exam day. Good luck one and all!
