1.4.33 If an ACE inhibitor is not tolerated, for example because of cough, offer an ARB to treat hypertension. [2019] Follow the MHRA safety advice on ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy, how to use for breastfeeding and clarification on breastfeeding. 1.4.34 Do not combine an ACE inhibitor with an ARB to treat hypertension. 1.4.35 Offer a calcium-channel blocker (CCB) to adults starting step 1 antihypertensive treatment who: are aged 55 or over and do not have type 2 diabetes or are of Black African or African Caribbean family origin and do not have type 2 diabetes (of any age). [2019] 1.4.36 If a CCB is not tolerated, for example because of oedema, offer a thiazide-like diuretic to treat hypertension. [2019] 1.4.37 If there is evidence of heart failure, offer a thiazide-like diuretic and follow NICE's guideline on chronic heart failure. [2019] 1.4.38 If starting or changing diuretic treatment for hypertension, offer a thiazide-like diuretic, such as indapamide in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide. 1.4.39 For adults with hypertension already having treatment with bendroflumethiazide or hydrochlorothiazide, who have stable, well- controlled blood pressure, continue with their current treatment. [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 1 treatment. Full details of the evidence and the committee's discussion are in evidence review E: step 1 treatment. 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. 