From the Guidelines
Hypertension treatment should start with ACE inhibitors, ARBs, dihydropyridine CCBs, or diuretics as first-line treatments.
Recommended Medications
- ACE inhibitors: recommended as first-line treatment for hypertension, especially in patients with heart failure or diabetes 1
- ARBs: recommended as first-line treatment for hypertension, especially in patients who cannot tolerate ACE inhibitors 1
- Dihydropyridine CCBs: recommended as first-line treatment for hypertension, especially in elderly patients or those with isolated systolic hypertension 1
- Diuretics: recommended as first-line treatment for hypertension, especially in patients with heart failure or resistant hypertension 1
Contraindications
- ACE inhibitors: contraindicated in pregnancy, renovascular disease, and significant renal impairment 1
- ARBs: contraindicated in pregnancy and significant renal impairment 1
- Beta blockers: contraindicated in asthma, chronic obstructive pulmonary disease, and peripheral vascular disease 1
- Diuretics: contraindicated in gout and significant renal impairment 1
Combination Therapy
- Combination of ACE inhibitor or ARB with dihydropyridine CCB or diuretic: recommended as initial therapy for most patients with confirmed hypertension 1
- Combination of beta blockers with other BP-lowering drugs: recommended in patients with compelling indications such as angina, post-myocardial infarction, or heart failure with reduced ejection fraction 1
Special Considerations
- African American patients: may benefit from the addition of hydralazine plus isosorbide dinitrate to their regimen 1
- Patients with heart failure: should be treated with ACE inhibitors, ARBs, beta blockers, and aldosterone receptor antagonists 1
- Patients with resistant hypertension: may benefit from the addition of spironolactone or eplerenone to their regimen 1
From the Research
Recommended Medications for Hypertension
The following medications are recommended for the treatment of hypertension:
- Thiazide or thiazide-like diuretics, such as hydrochlorothiazide or chlorthalidone 2
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, such as enalapril or candesartan 2
- Calcium channel blockers, such as amlodipine 2
- Beta-blockers, such as bisoprolol or metoprolol 3, 4
- Alpha-adrenergic blockers 3
- Direct renin inhibitors, such as aliskiren 5
Contraindications for Hypertension Medications
The following are contraindications for certain hypertension medications:
- ACE inhibitors and angiotensin receptor blockers should not be used simultaneously 6
- Beta-blockers may not be suitable for patients with certain co-morbidities, such as asthma or chronic obstructive pulmonary disease 3
- Calcium channel blockers may not be suitable for patients with certain co-morbidities, such as heart failure or peripheral artery disease 3
- Thiazide diuretics may not be suitable for patients with certain co-morbidities, such as gout or kidney disease 3
Special Considerations for Certain Patient Groups
The following are special considerations for certain patient groups:
- Elderly patients: may require lower doses of medications and closer monitoring of blood pressure and kidney function 3
- Patients with diabetes: may require closer monitoring of blood pressure and kidney function, and may benefit from ACE inhibitors or angiotensin receptor blockers 6
- Patients with heart failure: may require closer monitoring of blood pressure and kidney function, and may benefit from beta-blockers, ACE inhibitors, or angiotensin receptor blockers 6
- Patients with chronic kidney disease: may require closer monitoring of blood pressure and kidney function, and may benefit from ACE inhibitors or angiotensin receptor blockers 6
- Black patients: may benefit from thiazide diuretics or calcium channel blockers as first-line therapy 6