Step 2 treatment 1.4.40 Before considering next step treatment for hypertension discuss with the person if they are taking their medicine as prescribed and support adherence in line with NICE's guideline on medicines adherence. [2019] 1.4.41 If hypertension is not controlled in adults taking step 1 treatment of an ACE inhibitor or ARB, offer the choice of 1 of the following drugs in addition to step 1 treatment: a CCB or a thiazide-like diuretic. [2019] 1.4.42 If hypertension is not controlled in adults taking step 1 treatment of a CCB, offer the choice of 1 of the following drugs in addition to step 1 treatment: an ACE inhibitor or an ARB or a thiazide-like diuretic. [2019] 1.4.43 If hypertension is not controlled in adults of Black African or African Caribbean family origin who do not have type 2 diabetes taking step 1 treatment, consider an ARB, in preference to an ACE inhibitor, in addition to step 1 treatment. [2019] Step 3 treatment 1.4.44 Before considering next step treatment for hypertension: review the person's medications to ensure they are being taken at the optimal tolerated doses and discuss adherence (see recommendation 1.4.40). [2019] 1.4.45 If hypertension is not controlled in adults taking step 2 treatment, offer a combination of: an ACE inhibitor or ARB (see also recommendation 1.4.30 for people of Black African or African Caribbean family origin) and a CCB and a thiazide-like diuretic. [2019] For a short explanation of why the committee made the 2019 recommendations and how they might affect practice, see the rationale and impact section on step 2 and 3 treatment. Full details of the evidence and the committee's discussion are in evidence review F: step 2 and step 3 treatment. 