A 72-year-old female presents with elevated blood pressure readings consistently around 155/85 mmHg for the past 3 months. She has no significant past medical history other than well-controlled hypothyroidism on levothyroxine. She is otherwise healthy. Her eGFR is 70 mL/min/1.73m². Which of the following is the most appropriate initial pharmacotherapy for hypertension?

Question: A 72-year-old female presents with elevated blood pressure readings consistently around 155/85 mmHg for the past 3 months. She has no significant past medical history other than well-controlled hypothyroidism on levothyroxine. She is otherwise healthy. Her eGFR is 70 mL/min/1.73m². Which of the following is the most appropriate initial pharmacotherapy for hypertension?

Answer options:

• Hydrochlorothiazide 12.5 mg daily.
• Ramipril 5 mg daily. ✅ Amlodipine 5 mg daily.
• Metoprolol 25 mg twice daily.

Correct answer: Amlodipine 5 mg daily.

Explanation: According to Hypertension Canada guidelines, for adults over 60, a calcium channel blocker (like amlodipine) or a thiazide diuretic (like hydrochlorothiazide) are preferred first-line agents. Amlodipine is often well-tolerated and effective. An ACE inhibitor (ramipril) or beta-blocker (metoprolol) are also options but may not be first-line unless specific compelling indications exist.