Indication or contraindication | Antihypertensive drugs |
Compelling indications (major improvement in outcome independent of blood pressure) |
Heart failure with reduced ejection fraction | ACE inhibitor or ARB, beta blocker, diuretic, aldosterone antagonist* |
Postmyocardial infarction | ACE inhibitor or ARB, beta blocker, aldosterone antagonist |
Proteinuric chronic kidney disease | ACE inhibitor or ARB |
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 hyperplasia | Alpha blocker |
Essential tremor | Beta blocker (noncardioselective) |
Hyperthyroidism | Beta blocker |
Migraine | Beta blocker, calcium channel blocker |
Osteoporosis | Thiazide diuretic |
Raynaud phenomenon | Dihydropyridine calcium channel blocker |
Contraindications |
Angioedema | Do not use an ACE inhibitor |
Bronchospastic disease | Do not use a non-selective beta blocker |
Liver disease | Do not use methyldopa |
Pregnancy (or at risk for) | Do not use an ACE inhibitor, ARB, or renin inhibitor (eg, aliskiren) |
Second- or third-degree heart block | Do not use a beta blocker, nondihydropyridine calcium channel blocker unless a functioning ventricular pacemaker |
Drug classes that may have adverse effects on comorbid conditions |
Depression | Generally avoid beta blocker, central alpha-2 agonist |
Gout | Generally avoid loop or thiazide diuretic |
Hyperkalemia | Generally avoid aldosterone antagonist, ACE inhibitor, ARB, renin inhibitor |
Hyponatremia | Generally avoid thiazide diuretic |
Renovascular disease | Generally avoid ACE inhibitor, ARB, or renin inhibitor |