What is the best medication plan for a patient with cough due to ramipril in the context of hypertension management?

The most appropriate medication plan is to discontinue ramipril and add olmesartan/amlodipine. Ramipril, an ACE inhibitor, can often cause a persistent cough in some patients due to the accumulation of bradykinin. When a patient experiences this side effect, switching to an alternative class of antihypertensive medications is necessary to manage both the hypertension and the cough effectively.

Olmesartan, an angiotensin II receptor blocker (ARB), does not have the same cough-related side effects as ACE inhibitors and is effective in lowering blood pressure while providing cardiovascular protective benefits. Amlodipine, a calcium channel blocker, contributes more blood pressure reduction while also offering additional benefits such as vascular relaxation. This combination can optimize blood pressure control without the adverse effect of cough.

Discontinuing ramipril addresses the source of the cough immediately, and adding olmesartan and amlodipine provides a robust alternative regimen that effectively manages hypertension without inducing cough.

Other approaches, such as simply adding medications like amlodipine alone or switching to different drug combinations that still include a component that may cause cough, would not sufficiently resolve the patient's initial issue while managing their hypertension.