Table 1

Compelling and possible indications and contraindications for the major classes of antihypertensive drugs. Reproduced from Ramsay et al⁴ with permission of the BMJ Publishing Group

Class of drug		Indication				Contraindications
Class of drug		Compelling	Possible			Possible	Compelling
α Blockers	Prostatism	Dyslipidaemia		Postural hypotension	Urinary incontinence

ACE inhibitors	Heart failure, left ventricular dysfunction, type 1 diabetic nephropathy	Chronic renal disease^1-150, type 2 diabetic nephropathy		Renal impairment^1-150, peripheral vascular disease^1-151	Pregnancy, renovascular disease

Angiotensin II receptor antagonists	Cough induced by ACE inhibitor^1-152	Heart failure, intolerance of other antihypertensive drugs		Peripheral vascular disease^1-151	Pregnancy, renovascular disease

β Blockers	Myocardial infarction, angina	Heart failure^1-153		Heart failure^1-153, dyslipidaemia, peripheral vascular disease	Asthma or chronic obstructive pulmonary disease, heart block

Calcium antagonists (dihydropyridine)	Isolated systolic hypertension in elderly patients	Angina, elderly patients		–	–

Calcium antagonists (rate limiting)	Angina	Myocardial infarction		Combination with β blockade	Heart block, heart failure

Thiazides	Elderly patients	–		Dyslipidaemia	Gout

↵1-150 Angiotensin converting enzyme (ACE) inhibitors may be beneficial in chronic renal failure but should be used with caution. Close supervision and specialist advice are needed when there is established and significant renal impairment.
↵1-151 Caution with ACE inhibitors and angiotensin II receptor antagonists in peripheral vascular disease because of association with renovascular disease.
↵1-152 If ACE inhibitor indicated.
↵1-153 β Blockers may worsen heart failure, but in specialist hands by be used to treat heart failure.