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The paradigm shift Bosutinib molecular weight towards increased prescribing of ACEIs probably suggest that clinicians are more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs especially in a high cardiovascular risk group such as black hypertensive. However, we believe this is not readily clear and will require further studies to identify the factors underlining the significant increase in the prescribing of ACEIs. In addition, the use of thiazide diuretics as first line anti-hypertensive agents among Nigerians with documented high co-morbidities such as diabetes appeared inappropriate ab initio. This is because the landmark Anti-hypertensive and Lipid Lowering Treatment to prevent Heart Attack Trial (ALLHAT) upon which the recommendation to use to thiazides as first line agent is premised reported an increased incidence of hypokalemia, hyperglycemia and new-onset diabetes mellitus with thiazides relative to other anti-hypertensive agents such as ACEIs, ARBs and Alpelisib mw CCBs.25 Furthermore, other studies have also reported that the incidence of new-onset diabetes mellitus is highest with thiazides and lowest with ACEIs, ARBs.26-29 Besides, the increased incidence of thiazide-associated hypokalemia is a known contributor to insulin resistance and poor glucose utilization by target tissues.30,31 The long term macro-and microvascular complications associated with this biochemical derangement though well documented are open to confounding by the duration of follow-up and thus may not be readily apparent. Therefore, the shift in anti-hypertensive medicine prescribing pattern is a significant break from the past and it appeared to be based on evidence of obtainable short and long term therapeutic benefits. The significant prescribing shift from the short acting dihydropyridine CCBs [Nifedipine: 88.2% (past) versus 21.5% (current)] reported 10 years ago9 to a long acting CCBs [amlodipine: 11.8% (past) versus 78.5%% (current)] (pDabigatran medication adherence, smoother and better blood pressure control. This is more likely to contribute to the achievement of optimal therapeutic outcomes among patients with hypertension.32 The decline in the frequency of use of methyldopa between 10 years ago (23.3%)9 and now (9.7%) is also significant (p