Compelling and possible indications, contraindications, and cautions for the major classes of antihypertensive drugs
| Class of drug | Compelling indications | Possible indications | Caution | Compelling 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 Blockers | Benign prostatic hypertrophy | Postural hypotension, heart failure* | Urinary incontinence | |
| ACE inhibitors | Heart failure, LV dysfunction, post-MI or established CHD, type I diabetic nephropathy, 2° stroke prevention¶ | Chronic renal disease†, type II diabetic nephropathy, proteinuric renal disease | Renal impairment†, PVD‡ | Pregnancy, renovascular disease§ |
| ARBs | ACE inhibitor intolerance, type II diabetic nephropathy, hypertension with LVH, heart failure in ACE intolerant people, post-MI | LV dysfunction post-MI, intolerance of other antihypertensive drugs, proteinuric renal disease, chronic renal disease, heart failure† | Renal impairment† PVD‡ | Pregnancy, renovascular disease§ |
| β Blockers | MI, angina | Heart failure** | Heart failure**, PVD, diabetes (except with CHD) | Asthma/COPD, heart block |
| CCBs (dihydropyridine), CCBs (rate limiting) | Elderly, ISH, angina, CHD | Elderly, angina, MI | – | – |
| Combination with β blockade | Heart block, heart failure | |||
| Thiazide/thiazide-like diuretics | Elderly, ISH, heart failure, 2° stroke prevention | Gout†† | ||