In the example exercises, when a patient starts a new antihypertensive drug, the example exercises do NOT cover any monitoring or dose adjustments which would be needed for the patient to reach their optimal tolerated dose.

Instead, you are told that over the next month, the patient's blood pressure will be monitored and the dose of the antihypertensive drug adjusted as required, and that you will then see the patient in a month's time to see how well the patient has responded to treatment.

The chosen timescale of a month is arbitrary and used solely to make the exercises flow smoothly.

For actual patients, the time taken from starting an antihypertensive drug to reaching the optimal tolerated dose will vary from patient to patient; some patients will need less monitoring and fewer dose adjustments while others will require more monitoring and dose adjustments.

In some example exercises, the patient may need to stop taking one class of antihypertensive and start taking a different class of antihypertensive.

Regarding the timeframe in the example exercise, no time allowance is made for the patient to safely stop the first class of antihypertensive while tapering in (if applicable) the new antihypertensive: the patient simply stops the first class of antihypertensive and starts the second class of antihypertensive.

This lack of allowance for tapering (if applicable) is solely to make the exercises flow smoothly and to allow you to concentrate on which class of antihypertensive is required for a patient: you do not need to concentrate on the practicalities of stopping or starting antihypertensive drugs.

For actual patients, where it was applicable, drugs would need to be tapered correctly.

When working through an example exercise, you can assume that a patient correctly adheres to their drug regimen: any changes in a patient's blood pressure will be as a result of their antihypertensive drug(s) rather than because of problems with the patient's adherence to their regimen.

For people with cardiovascular disease, NICE Guideline NG136:
Hypertension in adults: diagnosis and management advises that, initially, you should follow the recommendations for disease-specific indications in the NICE guideline on their particular condition.

If a person's blood pressure is not controlled when offering treatment according to the recommendations for disease-specific indications, you should then offer treatment with antihypertensive drugs in line with the recommendations in NICE Guideline 136.

When working through an example exercise where a patient has cardiovascular disease, you can assume that:

• The patient has already been treated according to the NICE guideline for their particular condition and that their hypertension is still uncontrolled.
• The patient should be offered treatment with antihypertensive drugs in line with the recommendations in NICE Guidline 136.