| Drug Class / Salt Examples | CKD / Renal Disease | CLD / Liver Disease | Asthma / COPD | Pregnancy | Heart Failure (HFrEF) | Diabetes Mellitus | Special Notes / Comments |
|---|---|---|---|---|---|---|---|
| ACE Inhibitors (Enalapril, Lisinopril, Ramipril, Perindopril) | ✅ Preferred – renoprotective | ⚠️ Use low dose; monitor LFTs | ✅ Safe | ❌ Contraindicated (fetotoxic) | ✅ First-line | ✅ Reduces microalbuminuria | Stop if creatinine ↑ >30% or K⁺ >5.5 |
| ARBs (Losartan, Valsartan, Telmisartan, Candesartan, Olmesartan) | ✅ Preferred – renoprotective | ⚠️ Use with caution | ✅ Safe | ❌ Contraindicated | ✅ First-line | ✅ Excellent in nephropathy | Do not combine with ACEi |
| Thiazide / Thiazide-like Diuretics (Hydrochlorothiazide, Chlorthalidone, Indapamide) | ⚠️ Ineffective if eGFR <30 | ⚠️ May worsen hyponatremia | ✅ Safe | ⚠️ Avoid in late pregnancy | ⚠️ Caution (hypokalemia) | ✅ Useful for volume control | Avoid if gout or hyponatremia |
| Loop Diuretics (Furosemide, Bumetanide, Torsemide) | ✅ Safe; useful in volume overload | ⚠️ Monitor electrolytes | ✅ Safe | ⚠️ May cause fetal electrolyte imbalance | ✅ Preferred if edema | ✅ Use if CKD / edema | Replace thiazide if eGFR <30 |
| Calcium Channel Blockers (DHP) (Amlodipine, Felodipine, Nifedipine ER) | ✅ Safe | ✅ Safe | ✅ Safe | ✅ Preferred in pregnancy (esp. Nifedipine) | ⚠️ Caution – may worsen edema | ✅ Excellent add-on | Avoid short-acting nifedipine in emergency |
| Calcium Channel Blockers (Non-DHP) (Verapamil, Diltiazem) | ⚠️ Caution – bradycardia risk | ⚠️ Metabolized in liver | ✅ Safe | ⚠️ Limited data – avoid if possible | ⚠️ Avoid in HFrEF | ✅ Good for rate control (AF) | Avoid with β-blockers |
| Beta-Blockers (Cardioselective) (Bisoprolol, Metoprolol, Nebivolol, Atenolol) | ⚠️ Use low dose; adjust by renal function (Atenolol renally cleared) | ⚠️ Use low dose | ❌ Avoid non-selective (e.g., propranolol) | ⚠️ Labetalol / Metoprolol safe | ✅ First-line (HFrEF) | ✅ Good if CAD | Labetalol = DOC in pregnancy |
| Beta-Blockers (Non-Selective) (Propranolol, Carvedilol, Nadolol) | ⚠️ Adjust dose for hypertension treatment | ⚠️ Avoid in severe CLD | ❌ Contraindicated | ⚠️ Avoid (except labetalol) | ✅ Carvedilol OK in HFrEF | ✅ OK in diabetics | Avoid in asthma |
| Alpha-Blockers (Prazosin, Doxazosin, Terazosin) | ⚠️ Postural hypotension | ✅ Safe | ✅ Safe | ⚠️ Avoid unless essential | ⚠️ Not 1st-line | ✅ Useful for BPH | Start low to avoid syncope |
| Central Agents (Methyldopa, Clonidine, Moxonidine) | ✅ Safe | ⚠️ May cause sedation | ✅ Safe | ✅ Methyldopa = DOC in pregnancy | ⚠️ Not preferred | ⚠️ May cause drowsiness | Taper slowly; avoid abrupt withdrawal |
| Direct Vasodilators (Hydralazine, Minoxidil) | ✅ Safe | ⚠️ Metabolized hepatically | ✅ Safe | ✅ Hydralazine = DOC in pregnancy emergency | ✅ Useful add-on (esp. Hydralazine + Nitrate combo) | ⚠️ May cause reflex tachycardia | Always combine with beta-blocker & diuretic |
| Mineralocorticoid Receptor Antagonists (MRAs) (Spironolactone, Eplerenone) | ⚠️ Avoid if K⁺ >5.0 or eGFR <30 | ⚠️ Caution – hepatic metabolism | ✅ Safe | ⚠️ Avoid in pregnancy | ✅ Proven mortality benefit | ✅ Reduces proteinuria | Monitor K⁺ & renal function |
| Direct Renin Inhibitor (Aliskiren) | ❌ Avoid – renally cleared | ⚠️ Avoid | ✅ Safe | ❌ Contraindicated | ⚠️ Limited data | ⚠️ Not first-line | Do not combine with ACEi/ARB |
| Vasodilating Beta-blockers (Labetalol, Carvedilol, Nebivolol) | ✅ Preferred in CKD / DM | ⚠️ Dose adjust in CLD | ⚠️ Avoid non-selective if asthma | ✅ Labetalol = first-line in pregnancy | ✅ Carvedilol for HFrEF | ✅ Good metabolic profile | Labetalol safe for gestational HTN & pre-eclampsia |
Remember this hypertension treatment new guidelines to treat patients in better way.
