Guidelines for Selecting Initial Drug Treatment of Hypertension
Class of Drug | Compelling Indications | Possible Indications | Compelling Contraindications | Possible Contraindications |
---|---|---|---|---|
Diuretics | Heart failure | Gout | ||
Elderly pts | ||||
Systolic hypertension | ||||
Beta blockers | Angina After MI Tachyarrhythmias | Heart failure Pregnancy | Uncontrolled asthma and COPD Heart blocka | Athletes and physically active pts Peripheral vascular disease |
ACE inhibitors | Heart failure | Chronic renal parenchymal disease | Pregnancy | |
LV dysfunction | Hyperkalemia | |||
After MI | Bilateral renal artery stenosis | |||
Diabetic nephropathy | ||||
Angiotensin receptor blockers | ACE inhibitor cough Heart failure Diabetic nephropathy | Chronic renal parenchymal disease | Pregnancy Bilateral renal artery stenosis Hyperkalemia | |
Calcium channel blockers | Angina Elderly pts Systolic hypertension | Peripheral vascular disease | Heart blockb | Congestive heart failurec |
aSecond- or third-degree atrioventricular block.
bSecond- or third-degree atrioventricular block with verapamil or diltiazem.
cVerapamil or diltiazem.
Abbreviations: ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease.