From the Guidelines
In first-degree AV block, the preferred antihypertensive medications are ACE inhibitors, ARBs, or diuretics, as they effectively lower blood pressure without significantly affecting AV nodal conduction. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, these medications are recommended as first-line treatment options.
Some key points to consider when selecting antihypertensive medications in patients with first-degree AV block include:
- ACE inhibitors, such as lisinopril, can be started at a dose of 10mg daily 1
- ARBs, such as losartan, can be started at a dose of 50mg daily 1
- Diuretics, such as hydrochlorothiazide, can be started at a dose of 12.5mg daily 1
- If additional blood pressure control is needed, consider adding a long-acting dihydropyridine calcium channel blocker like amlodipine (5mg daily) 1
- Regular monitoring of the PR interval on ECG is recommended when initiating or adjusting antihypertensive therapy in patients with first-degree AV block 1
- The underlying cause of the AV block should also be investigated, as it may influence antihypertensive selection 1
It's worth noting that beta blockers, such as atenolol, metoprolol, and propranolol, are not recommended as first-line agents in patients with first-degree AV block, unless the patient has ischemic heart disease or heart failure 1. Calcium channel blockers, other than long-acting dihydropyridine agents, should also be used with caution in patients with first-degree AV block, as they can worsen the conduction delay 1.
From the Research
Antihypertensive Treatment in First-Degree AV Block
- The treatment of hypertension in patients with first-degree AV block should be approached with caution, as some antihypertensive drugs can worsen AV block 2, 3.
- Thiazide diuretics, such as chlortalidone or hydrochlorothiazide, are often recommended as first-line treatment for hypertension in patients without diabetes or cardiovascular disease 4.
- Beta-blockers can also be used to treat hypertension, but they may worsen AV block in some patients 2, 3.
- Calcium-channel blockers, such as verapamil or diltiazem, can also be used to treat hypertension, but they may worsen AV block in some patients 2, 3.
- ACE inhibitors, such as captopril, lisinopril, or ramipril, can be used to treat hypertension, and they may be a good alternative for patients with first-degree AV block who cannot tolerate other antihypertensive drugs 4, 5.
Considerations for Patients with First-Degree AV Block
- Patients with first-degree AV block should be monitored closely for worsening of AV block when starting or changing antihypertensive medications 2, 3.
- The choice of antihypertensive medication should be individualized based on the patient's specific condition and medical history 4, 5.
- Patients with first-degree AV block may require more frequent follow-up and monitoring to ensure that their AV block is not worsening 6.
- In some cases, pacemaker therapy may be necessary to treat symptomatic first-degree AV block 6.