[Hero]

You have asked a vague question. In my posting above, you might have noticed that white ppl RESPONDS better to A or B and blacks to C or D. In Nepal no such study has been conducted that's why we rely on international guidelines/ and our own experience. Hypertension is not like APD where you give omeprazole or ranitidine and ask the patient to go home. In your question are you asking about a young Nepalese with hypertension or an old Nepalese dude? Before treating any patient we see whether it is a primary or secondary one? Is there any risk factor? Target organ damage? Then we group that patient as stage 1 ,2 or 3 (in China)--JNC-7 divides into stage 1 and 2 only---and risk group A, B or C???
Lets assume you are talking about a Nepalese male with age more than 55 yrs--essential HTN---stage 1 in risk group A or B---I will suggest him for lifestyle modification, if in risk group C--then I will start medication. I was tought to start with C or D, and I start with D (thiazide group--not frusemide). If the pt is younger (age less than 55, then ACE-I (any type--but I give Fosinopril--don't know whether it is available in Nepal or not) or ARB if ACE-I not tolerated. If pt with DM, then ACE-I or ARB---if with angina then beta blockers--so n so n so. And if the pt doesn't respond to this or for the pts in other stages I give 2 drug combi---usually A+D or A+C, if 3 needed A+C+D. Don't forget to monitor electrolytes frequently. If BP still not controlled then have to consider other things as well. This is what I frequently prefer in my practice and doesn't mean that all do like this.