In severe cases of hypertension, which additional class of anti-hypertensives may be added to ACE inhibitors?

In cases of severe hypertension, thiazide diuretics are often added to ACE inhibitors to enhance blood pressure control. Thiazides work by promoting the excretion of sodium and water, which reduces blood volume and subsequently lowers blood pressure. Their mechanism complements that of ACE inhibitors, which primarily work by inhibiting the renin-angiotensin-aldosterone system. This combination can lead to a more significant overall reduction in blood pressure, providing a synergistic effect.

Using thiazides with ACE inhibitors can also help to mitigate potential side effects of ACE inhibitors alone, such as cough and angioedema, as well as contribute to improved outcomes for patients who may develop resistance to monotherapy as their condition progresses. The use of thiazide diuretics is particularly favored in the management of hypertension due to their proven efficacy and role in lowering cardiovascular risk.

The other choices, while beneficial in different contexts, do not serve the primary role of enhancing antihypertensive efficacy as directly and effectively as thiazides when paired with ACE inhibitors for severe hypertension management. For example, calcium channel blockers are sometimes used as alternatives to thiazides but do not have the same complementary effect on fluid balance. Statins are primarily aimed at cholesterol management and