A 62-year-old male with a history of hypertension, dyslipidemia, and osteoarthritis presents to your pharmacy. He is currently taking ramipril 10 mg daily, atorvastatin 40 mg daily, and celecoxib 200 mg daily for his knee pain. His blood pressure today is 158/88 mmHg. His most recent eGFR was 55 mL/min/1.73m². Which of the following is the most appropriate initial recommendation to further manage his hypertension?

Question: A 62-year-old male with a history of hypertension, dyslipidemia, and osteoarthritis presents to your pharmacy. He is currently taking ramipril 10 mg daily, atorvastatin 40 mg daily, and celecoxib 200 mg daily for his knee pain. His blood pressure today is 158/88 mmHg. His most recent eGFR was 55 mL/min/1.73m². Which of the following is the most appropriate initial recommendation to further manage his hypertension?

Answer options:

• Increase ramipril to 20 mg daily. ✅ Add amlodipine 5 mg daily.
• Switch celecoxib to acetaminophen.
• Add hydrochlorothiazide 12.5 mg daily.

Correct answer: Add amlodipine 5 mg daily.

Explanation: According to Hypertension Canada guidelines, a calcium channel blocker like amlodipine is a preferred second-line agent for uncontrolled hypertension, especially in patients already on an ACE inhibitor. NSAIDs can elevate blood pressure and should be considered for discontinuation, but a direct medication addition is often needed first for significant BP elevation. Hydrochlorothiazide might be less effective given his eGFR.