Table 3.9-3. Preferred indications and contraindications for the use of key classes of antihypertensive drugs

Drug class

Preferred indications

Contraindications

Diuretics

 

Thiazide and thiazide-like diuretics

Isolated systolic hypertension (in the elderly), HF, hypertension in black patients

Gout, pregnancy,a hypercalcemia,a hyponatremia, hypokalemiaa

Aldosterone antagonists

HF, prior MI, prevention of AF (may be considered)

Hyperkalemia

Beta‑blockers

Angina pectoris, prior MI, HF, aortic aneurysm, pregnancy, prevention of AF (may be considered), ventricular rate control in AF

Asthma, second-degree/third-degree AV block, peripheral artery disease,a metabolic syndrome,a IGT,a COPD (except for beta-blockers with vasodilation effects),a athletes or physically active patients

Calcium channel blockers

 

Dihydropyridines

LV hypertrophy, asymptomatic atherosclerosis, angina pectoris, peripheral artery disease, isolated systolic hypertension (in the elderly), pregnancy, hypertension in black patients

Tachyarrhythmia,a HFa

Verapamil and diltiazem

Ventricular rate control in AF, LV hypertrophy, asymptomatic atherosclerosis, angina pectoris, peripheral artery disease, isolated systolic hypertension (in the elderly), metabolic syndrome, pregnancy, hypertension in black patients

Second-degree/third-degree AV block, severe LV dysfunction, HF

ACEIs

LV hypertrophy, asymptomatic atherosclerosis, microalbuminuria, renal dysfunction, prior MI, HF, prevention of AF (may be considered), end-stage renal failure/proteinuria, peripheral artery disease, metabolic syndrome, DM

Pregnancy, angioedema, hyperkalemia, bilateral renal artery stenosis, renal artery stenosis of a solitary functioning kidney

ARBs

LV hypertrophy, microalbuminuria, renal dysfunction, previous MI, HF, prevention of AF (may be considered), end-stage renal failure/proteinuria, metabolic syndrome, DM

Pregnancy, hyperkalemia, bilateral renal artery stenosis, renal artery stenosis of a solitary functioning kidney

a Relative contraindications.

Adapted from Can J Cardiol. 2018;34(5):506-525, Eur Heart J. 2018; 29(33):3021-3104, and Eur Heart J. 2013;34(28):2159-219.

ACEI, angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin receptor blocker; AV, atrioventricular; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; HF, heart failure; IGT, impaired glucose tolerance; LV, left ventricle; MI, myocardial infarction.