Considerations with specific antihypertensive agents
a. β-Blockers i. Caution with asthma, severe chronic obstructive pulmonary disease (especially higher doses) because of pulmonary β-receptor blockade ii. Increased risk of developing diabetes compared with ACE inhibitor, ARB, and calcium channel blocker; use caution in patients at high risk of diabetes mellitus (e.g., family history, obese) iii. May mask some signs of hypoglycemia in patients with diabetes mellitus iv. May cause depression b. Thiazides i. May worsen gout by increasing serum uric acid ii. Increased risk of developing diabetes compared with ACE inhibitor, ARBs, and calcium channel blocker; use caution in patients at high risk of diabetes mellitus (e.g., family history, obese) iii. May assist in the management of osteoporosis by preventing urine calciu شloss c. ACE inhibitors and ARBs i. Contraindicated in pregnancy
ii. Contraindicated with bilateral renal artery stenosis iii. Monitor K closely, especially if renal insufficiency exists or another K-sparing drug is in use. iv. The presence of diabetic nephropathy should influence the choice of ACE inhibitor versus ARBs iiv cough with ACEIs stop ACEIs and initiate ARBs
i. Methyldopa and hydralazine are recommended if a new therapy is initiated. ii. Most antihypertensives (except for ACE inhibitors and ARBs) can be safely continued in pregnancy .
a. Have the patient return in 4 weeks to assess efficacy. b. May have patient follow up sooner if BP particularly worrisome . c. If there is an inadequate response from the first agent (and adherence verified) and no compelling . indication exists, initiate therapy with a drug from a different class.