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.