In a follow-up for a patient on hydrochlorothiazide and lisinopril with hypertension, what is the appropriate next step if BP is still high?

When managing a patient with hypertension who is already on hydrochlorothiazide and lisinopril but still presents with high blood pressure, adding a medication that works through a different mechanism can provide an effective way to achieve better blood pressure control. Amlodipine, a calcium channel blocker, acts by relaxing the blood vessels and reducing peripheral vascular resistance, making it a suitable choice to enhance the antihypertensive effects of the existing medications.

By combining different classes of antihypertensive medications, it is possible to target various pathways that contribute to elevated blood pressure. In this case, although the patient is on a thiazide diuretic and an ACE inhibitor, which are typically effective, their blood pressure remains high, indicating the need for additional therapeutic options. Amlodipine can be particularly beneficial in patients who may also have issues related to vascular tone.

The other options, while they may offer benefits in certain situations, do not complement the regimen as effectively as adding amlodipine. For instance, spironolactone is a potassium-sparing diuretic that may be useful in certain cases, especially in patients with heart failure or those who experience hypokalemia but might not provide the same immediate impact on blood pressure