Antihypertensives

Classification and Management of Blood Pressure

for Adults Aged 18 Years or Older

Clinical Trial and Guideline Basis for Compelling
Indications for Individual Drug Classes
Algorithms for Treatment o Hypertension
Algorithm of Choice of drugs
If therapy is initiated with a beta-blocker and a
second drug is required, add a calcium-channel
blocker rather than a thiazide-type diuretic to
reduce the patients risk of developing diabetes.
In patients whose blood pressure is well
controlled (that is, 140/90 mmHg or below) with
a regimen that includes a beta-blocker, long-
term management should be considered as part
of their routine review. In these patients there is
no absolute need to replace the beta-blocker
with an alternative agent.

Offer patients with isolated systolic
hypertension (systolic BP 160 mmHg or
more) the same treatment as patients with
both raised systolic and diastolic blood
pressure.
Where possible, recommend treatment
with drugs taken only once a day.
A meta-analysis found that patients adhered to once-
daily blood pressure lowering regimens better than to
regimens requiring two or more doses a day (91% versus
83%). Similarly, once-daily regimens were better
adhered to than twice-daily regimens (93% versus 87%).

Contraindications for
antihypertensives
Angioedema :ACE inhibitor
Bronchospastic disease :Beta blocker
Depression :Reserpine
Liver disease :Methyldopa
Pregnancy :ACE inhibitor, ARB (includes
women likely to become pregnant)
Second or third degree heart block :Beta
blocker, nondihydropyridine calcium channel
blocker

May have adverse effect on comorbid
conditions
Depression: Beta blocker, central alpha agonist
Gout: Diuretic
Hyperkalemia: Aldosterone antagonist, ACE
inhibitor, ARB
Hyponatremia: Thiazide diuretic
Renovascular disease: ACE inhibitor or ARB
Compelling indications
Systolic heart failure: ACE inhibitor or ARB, beta blocker, diuretic,
aldosterone antagonist
Post-myocardial infarction: ACE inhibitor, beta blocker, aldosterone
antagonist
Proteinuric chronic renal failure: ACE inhibitor and/or ARB
High coronary disease risk: Diuretic (ALLHAT), perhaps ACE inhibitor
(HOPE)
Diabetes mellitus (no proteinuria): Diuretic (ALLHAT), perhaps ACE inhibitor
(HOPE)
Angina pectoris: Beta blocker, calcium channel blocker
Atrial fibrillation rate control: Beta blocker, nondihydropyridine calcium
channel blocker
Atrial flutter rate control: Beta blocker, nondihydropyridine calcium channel
blocker
Likely to have a favorable effect on
symptoms in comorbid conditions
Benign prostatic hypertrophy: Alpha blocker
Essential tremor: Beta blocker
(noncardioselective)
Hyperthyroidism: Beta blocker
Migraine: Beta blocker, calcium channel blocker
Osteoporosis:Thiazide diuretic
Perioperative hypertension: Beta blocker
Raynaud's syndrome: Dihydropyridine calcium
channel blocker