Table 9

 Compelling and possible indications, contraindications, and cautions for the major classes of antihypertensive drugs

Class of drugCompelling indicationsPossible indicationsCautionCompelling contraindications
*HF when used as monotherapy; †ACE inhibitors or ARBs may be beneficial in chronic renal failure but should only be used with caution, close supervision, and specialist advice; ‡caution with ACE inhibitors and ARBs in peripheral vascular disease because of the association with renovascular disease; §ACE inhibitors and ARBs are sometimes used in people with renovascular disease under specialist supervision; ¶in combination with a thiazide/thiazide-like diuretic; **β blockers are increasingly used to treat stable heart failure; however, β blockers may worsen heart failure; ††thiazide/thiazide-like diuretics may sometimes be necessary to control BP in people with a history of gout, ideally used in combination with allopurinol.
ACE, angiotensin converting enzyme; ARBs, angiotensin II receptor blockers; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; ISH, isolated hypertension; LVH, left ventricular hypertrophy; MI, myocardial infarction; PVD, peripheral vascular disease.
α BlockersBenign prostatic hypertrophyPostural hypotension, heart failure*Urinary incontinence
ACE inhibitorsHeart failure, LV dysfunction, post-MI or established CHD, type I diabetic nephropathy, 2° stroke prevention¶Chronic renal disease†, type II diabetic nephropathy, proteinuric renal diseaseRenal impairment†, PVD‡Pregnancy, renovascular disease§
ARBsACE inhibitor intolerance, type II diabetic nephropathy, hypertension with LVH, heart failure in ACE intolerant people, post-MILV dysfunction post-MI, intolerance of other antihypertensive drugs, proteinuric renal disease, chronic renal disease, heart failure†Renal impairment† PVD‡Pregnancy, renovascular disease§
β BlockersMI, anginaHeart failure**Heart failure**, PVD, diabetes (except with CHD)Asthma/COPD, heart block
CCBs (dihydropyridine), CCBs (rate limiting)Elderly, ISH, angina, CHDElderly, angina, MI
Combination with β blockadeHeart block, heart failure
Thiazide/thiazide-like diureticsElderly, ISH, heart failure, 2° stroke preventionGout††