Compelling Indications for Specific Antihypertensive Drugs

• CHF: ACEI/ARB + BB + diuretic + spironolactone. Avoid CCBs in any patients with decreased EF.
• AF: BB or CCB (Diltiazem) for rate control.
• Post –MI/Clinical CAD: ACEI/ARB AND BB, +- aldosterone antagonist
• CAD: ACEI, BB, diuretic, CCB
• Angina / Ischemic heart disease: BB (1st line) or CCB
• High CAD risk: BB (1st line); ACEI, CCB, thiazide.
• Diabetes: ACEI (renoprotective)/ARB, CCB, diuretic. May use ACEI + CCB for combined treatment.
• CKD: ACEI/ARB
• Hx of thoracic aortic aneurysm: BB or losartan.
• Hx of Stroke / Recurrent stroke prevention: ACEI, Thiazide diuretic.
• Pregnancy: labetalol (first-line), nifedipine, methyldopa, hydralazine
• Black patient: Diuretic or CCB. Response rate by agent: diltiazem (64%); HCTZ (58%); clonidine (45%), and prazosin (38%).
• BPH: Alpha blocker
• Migraines, essential tremor, significant anxiety/phobia, hyperthyroid: BB (Propranolol).
• Nephrolithiasis or osteoporosis: Thiazides–decrease renal calcium clearance.
• Younger patients (<50 y): ACEI or ARB
• Elderly: Low does thiazide (1st line) for most; consider ACE inhibitor/ARB, CCB

*Why are ACEIs used for HF and MI?

*How are ACEIs renoprotective?

*Side effects of ACEIs.

Reference