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Table 117-2

Guidelines for Selecting Initial Drug Treatment of Hypertension

Class of DrugCompelling IndicationsPossible IndicationsCompelling ContraindicationsPossible Contraindications
DiureticsHeart 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 inhibitorsHeart failureChronic renal parenchymal diseasePregnancy
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 diseaseHeart blockbCongestive 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.