HTN first line drug

HTN first line drug - thiazide diuretic (beta blockers, ACE are other choices)

a. Pt is hypertensive +:

i. AA: THZ, CCB as they have low plasma renin level, and higher plasma volume, and higher vascular resistance than white patients.

ii. Caucasian, young patient: BB, ACEI

iii. Elderly: THZ. 2nd line: ACE, ARB

iv. S/p MI: BB, ACEI, ARB, ALDO ANT

v. Angina: BB

vi. DM, CKD: ACEI, ARB, CCB. C/I: BB, THZ

vii. CHF: THZ, ACEI, ARB, ALDO ANT, BB C/I: BB (in severe systolic dysfunction)

viii. Pregnant: Alpha-methyldopa, hydralazine. C/I: THZ, ACEI

ix. Hyperlipidemia: ACEI, CCB, a-blocker, BB with ISA. C/I: b-blocker, THZ

x. PVD: CCB. C/I: b-blocker

• • ACEI C/I in bilateral renal artery stenosis, but is drug of choice in unilateral renal artery stenosis.

  • HTN pt with asthma and COPD: BB is C/I.

  • HTN pt with cardiac dysrrhythmia on digitalis: ACEI, and diuretics are C/I.

  • HTN pt with impotence: BB, THZ, clonidine, methyldopa are C/I

  • HTN pt with depression: BB is C/I

  • HTN pt with gout: THZ and other diuretic are C/I