First line agents for hypertension are one of three classes:
- ACE inhibitors or Angiotensin receptor blockers
- Calcium channel blockers
Drug preference is mainly influenced by co-morbidities and contraindications, rather than a simple age cut-off.
Co-morbidities & Preferred anti-hypertensive agents
Renal dysfunction, Microalbuminuria, ESRD, Proteinuria
Diuretics, bB, ACEi/ARB, spironolactone
ARB/ACEi, bB, spironolactone
AF, rate control
Isolated systolic hypertension in elderly
Methyldopa (category B);
bB, CCB (category C)
Peripheral arterial disease
Anti-hypertensives agents & Contraindications
Gout. Metabolic syndrome. Glucose intolerance, Pregnancy, Hypercalcaemia, Hypokalaemia
Asthma. AV block. Metabolic syndrome. Glucose intolerance. Athletes and physically active patients. COPD unless vasodilator bB.
Tachyarrhythmia. ?Heart failure.
Verapamil, Diltiazem CCB
AV block. Severe LV dysfcuntion. Heart failure.
ACEi / ARB
Pregnancy. Women with child bearing potential. Angioneurotic oedema.
HyperK. Bilateral renal artery stenosis
Acute or severe renal failure. HyperK
Author: Dr Andrew To