A 45 years old female patient presents with essential hypertension. She was started on ramipril, furosemide and aspirin. 2 weeks later she presented with well controlled blood pressure but developed persistent dry cough. The alteration that has to be done for her cough without affecting her controlled blood pressure is

Answer: d) Replace ramipril with other angiotensin receptor blockers like valsartan (HARRISON 19TH ED, P-1623)HYPERTENSION TREATMENT GUIDELINES (CMDT 2015) Persons < 55 years and not blackPersons > 55 years or blackStep 1ACE inhibitor or ARBCalcium channel blocker (CCB) - preferred Thiazide like diuretic - if CCB is not tolerated or the person has edema, evidence of heart failure or a high risk of heart failureStep 2ACE inhibitor or ARB + CCBStep 3ACE inhibitor or ARB + CCB + Thiazide like diureticStep 4Resistant HypertensionACE inhibitor or ARB + CCB + Thiazide like diuretic + Spironolactone or a/B blockerRecommendations for initial treatment - ACE inhibitors, ARBs, and calcium channel blockersA chronic dry cough is seen in 10% of patients using ACE inhibitors, and may require stopping the drugBecause of adverse metabolic profile, initial therapy with thiazides - restricted to older patientsThiazides are acceptable as first-line therapy in blacksBeta-blockers should no longer be considered ideal first-line drugs in the treatment of hypertension without compelling indications for their useDiabetic hypertensive patientsTarget BP: <130/80 mm HgBecause of the beneficial effects of ACE inhibitors in diabetic nephropathy, they should be part of the initial treatment regimenMost diabetic patients require combinations of three to five agents to achieve target blood pressure, usually including a diuretic and a calcium channel blocker or beta-blocker