A. Commence ramipril 2.5 mg daily and monitor potassium and creatinine in 1–2 weeks

B. Increase amlodipine to 15 mg daily to achieve blood pressure target

C. Commence ramipril 5 mg daily plus irbesartan 150 mg daily for dual RAAS blockade

D. Refer to a nephrologist and defer antihypertensive changes until specialist review

E. Increase gliclazide MR to 120 mg daily to improve glycaemic control