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 drugIndicationContraindications
α BlockersProstatismDyslipidaemiaPostural hypotensionUrinary incontinence
ACE inhibitorsHeart failure, left ventricular dysfunction, type 1 diabetic nephropathyChronic renal disease1-150, type 2 diabetic nephropathyRenal impairment1-150, peripheral vascular disease1-151 Pregnancy, renovascular disease
Angiotensin II receptor antagonistsCough induced by ACE inhibitor1-152 Heart failure, intolerance of other antihypertensive drugsPeripheral vascular disease1-151 Pregnancy, renovascular disease
β BlockersMyocardial infarction, anginaHeart failure1-153 Heart failure1-153, dyslipidaemia, peripheral vascular diseaseAsthma or chronic obstructive pulmonary disease, heart block
Calcium antagonists (dihydropyridine)Isolated systolic hypertension in elderly patientsAngina, elderly patients
Calcium antagonists (rate limiting)AnginaMyocardial infarctionCombination with
β blockade
Heart block, heart failure
ThiazidesElderly patientsDyslipidaemiaGout
  • 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.