This has been addressed before, see suggestion history
AMBOSS states: “Patient race: For Black patients (including individuals with diabetes) without CHE or CKD, initial antihypertensive therapy. should include a thiazide-type diuretic or CCB.” Then in the text bubble says: Previous guidelines have recommended using only diuretics or CCBs to treat hypertension in Black patients without CKD. These recommendations have been criticized for multiple reasons, including making the incorrect assumption that all Black individuals are “salt-sensitive” with low renin levels and therefore particularly responsive to diuretics, and for denying Black patients the potential benefits of renin-angiotensin-aldosterone system inhibitors. Although not explicitly recommended by current US guidelines, experts have advised that a combination medication is a reasonable strategy for Black patients. The 2020 ISH guideline recommends the combination of a CCB and either a thiazide-type diuretic or an ARB.
Source: https://next.amboss.com/us/article/Xh09cf?q=hypertension#Zce0d4554dd0bc7f9fba742d2827ffc63
can perhaps add in extra that ARBs can also be considered as apart of combination therapy with CCB or thiazides
I think adding that to the extra would be good. Was under the impression that the guideline was just HCTZ + CCB. Agree with the sentiment presented by OP but think as a Step prep resource we have to wait for guidelines to shift before making any changes to the main content here.
Do think we could improve the text and make it less ambiguous. Maybe: “In Black patients, initial first-line treatment for primary hypertension includes at least one of {{c1::CCB}} or {{c2::HCTZ}}”?
And I’m not seeing any specific indications for elderly patients in that set of guidelines or AMBOSS (they say it is the same as for younger adults)
(https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15026)
I like @Cameron 's version
On that note I think there should be a feature to see more than one suggestion for a card simultaneously
@AnKing-Maintainers We’ve gotten a couple suggestions like this. Want to get this right so if anyone has input please chime in. Currently thinking of updating card to read as:
Text:
In Black patients, initial first-line treatment for primary hypertension includes at least one of {{c1::CCB}} or {{c2::HCTZ}}
Extra:
The 2020 ISH Global Hypertension Practice Guidelines list first-line pharmacologic treatment of HTN in Black patients as either HCTZ + DHP-CCB or ARB + DHP-CCB
Support CTE’s version
support
Change “at least one of” to “either” - support
“In Black patients, initial first-line treatment for primary hypertension includes either a(n) dihydropyridine Ca2+ channel blocker or hydrochlorothiazide”
As of August 2025, I am pretty sure that this has been updated by the American Heart Association and is no longer the recommendation.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356
Thank you, I don’t think AMBOSS has updated this yet. I don’t see anything in UWorld library about race
We can add a comment about this update in the extra section, and we’ll need to see whether the AMBOSS or UWorld questions on this have been updated to reflect recent changes
Need to check:
#AK_Step2_v12::#AMBOSS::5laixk