Antihypertensives are drugs that Tx hypertension, to prevent complications (e.g. stroke, MI, heart failure).

• Thiazide diuretics, usually considered first line
• ACE inhibitors, considered near-first line
• ARB's
• Reduce heart rate:
  • Calcium channel blockers, considered near-first line
  • Beta blockers

As the INITIAL drug:

• In mild BP elevation, lifestyle changes and observation are recommended BEFORE trialling drugs. However, there can be damage to body before BP is even elevated, so Pt's even w/ normal BP but show evidence of HTN-related nephropathy, proteinuria, atherosclerotic vascular disease, as well as other HTN-related organ damage, can be started
• Often MORE than 1 agent is required to effectively lower HTN
• The starting drug depends on age, race, and other medical conditions, including:
  • Younger Pt's of non-African ethnicity, started on ACEi's
  • For Pt's >55yo, use CCB's, thiazide diuretics
  • For anxiety, tremor, use beta blockers
  • For asthmatics, avoiding beta blockers
  • For diabetes, ACEi's or ARB's can be renal protective, as well as prevent retinal complications
  • For gout, diuretics can worsen, and the ARB losartan can reduce blood urate
  • For kidney stones, use thiazide diuretics
  • For heart block, greater than first degree, avoid beta blockers, and non-dihydropyridine CCB's
  • For heart failure, avoid non-dihydropyridine CCB's. Outcomes however, improve with beta blockers, diuretics, ACEi's, ARB's, and aldosterone antagonists
  • For pregnancy, the alpha agonist methyldopa is considered first line, but the beta blockers lebetalol and metoprolol are acceptable. The beta blocker atenolol however, is teratogenic. ACEi's and ARB's are contraindicated in women who are or intend on becoming pregnant
  • In African-Americans, thiazide diuretics and CCB's were found to be more effective than beta blockers, ACEi's, or ARB's
• Dual therapy involves ACEi +CCB or thiazide diuretic
• Triple therapy involves ACEi +CCB +thiazide diuretic
• Triple therapy is +further diuretic (e.g. spironolactone or furosemide), an alpha or beta blocker

• Reduction of BP by 5mmHg:
  • Decreases stroke by 34%
  • Decreases IHD by 21%
  • Decreases likelihood of dementai, heart failure, and mortality from cardiovascular disease

• Hypertension