Which drugs classes are recommended for use in high-risk conditions resulting from hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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In compelling cases, another class of drugs should be initiated. An ACEI, ARB, and CCB are all acceptable alternative agents. Beta-blockers are no longer considered first-line therapy for hypertension, but these agents can be used in cases with compelling indications aside from hypertension, such as systolic heart failure. There are several opinions regarding which antihypertensive agents to use initially, because some patients may respond to a therapy that others may not.

The following are drug class recommendations for compelling indications based on various clinical trials [5] :

  • Heart failure: Diuretic, beta-blocker, ACEI/ARB, aldosterone antagonist

  • Following myocardial infarction: Beta-blocker, ACEI

  • Diabetes: ACEI/ARB

  • Chronic kidney disease: ACEI/ARB

Note that different stages of these diseases may alter their treatment management.

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