| 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) | β Preferred β renoprotective | β οΈ Use low dose; monitor LFTs | β Safe | β Contraindicated (fetotoxic) | β First-line | β Reduces microalbuminuria | Stop if creatinine β >30% or KβΊ >5.5 |
| ARBs (Losartan, Valsartan, Telmisartan, Candesartan, Olmesartan) | β Preferred β renoprotective | β οΈ Use with caution | β Safe | β Contraindicated | β First-line | β Excellent in nephropathy | Do not combine with ACEi |
| Thiazide / Thiazide-like Diuretics (Hydrochlorothiazide, Chlorthalidone, Indapamide) | β οΈ Ineffective if eGFR <30 | β οΈ May worsen hyponatremia | β Safe | β οΈ Avoid in late pregnancy | β οΈ Caution (hypokalemia) | β Useful for volume control | Avoid if gout or hyponatremia |
| Loop Diuretics (Furosemide, Bumetanide, Torsemide) | β Safe; useful in volume overload | β οΈ Monitor electrolytes | β Safe | β οΈ May cause fetal electrolyte imbalance | β Preferred if edema | β Use if CKD / edema | Replace thiazide if eGFR <30 |
| Calcium Channel Blockers (DHP) (Amlodipine, Felodipine, Nifedipine ER) | β Safe | β Safe | β Safe | β Preferred in pregnancy (esp. Nifedipine) | β οΈ Caution β may worsen edema | β Excellent add-on | Avoid short-acting nifedipine in emergency |
| Calcium Channel Blockers (Non-DHP) (Verapamil, Diltiazem) | β οΈ Caution β bradycardia risk | β οΈ Metabolized in liver | β Safe | β οΈ Limited data β avoid if possible | β οΈ Avoid in HFrEF | β Good for rate control (AF) | Avoid with Ξ²-blockers |
| Beta-Blockers (Cardioselective) (Bisoprolol, Metoprolol, Nebivolol, Atenolol) | β οΈ Use low dose; adjust by renal function (Atenolol renally cleared) | β οΈ Use low dose | β Avoid non-selective (e.g., propranolol) | β οΈ Labetalol / Metoprolol safe | β First-line (HFrEF) | β Good if CAD | Labetalol = DOC in pregnancy |
| Beta-Blockers (Non-Selective) (Propranolol, Carvedilol, Nadolol) | β οΈ Adjust dose for hypertension treatment | β οΈ Avoid in severe CLD | β Contraindicated | β οΈ Avoid (except labetalol) | β Carvedilol OK in HFrEF | β OK in diabetics | Avoid in asthma |
| Alpha-Blockers (Prazosin, Doxazosin, Terazosin) | β οΈ Postural hypotension | β Safe | β Safe | β οΈ Avoid unless essential | β οΈ Not 1st-line | β Useful for BPH | Start low to avoid syncope |
| Central Agents (Methyldopa, Clonidine, Moxonidine) | β Safe | β οΈ May cause sedation | β Safe | β Methyldopa = DOC in pregnancy | β οΈ Not preferred | β οΈ May cause drowsiness | Taper slowly; avoid abrupt withdrawal |
| Direct Vasodilators (Hydralazine, Minoxidil) | β Safe | β οΈ Metabolized hepatically | β Safe | β Hydralazine = DOC in pregnancy emergency | β Useful add-on (esp. Hydralazine + Nitrate combo) | β οΈ May cause reflex tachycardia | Always combine with beta-blocker & diuretic |
| Mineralocorticoid Receptor Antagonists (MRAs) (Spironolactone, Eplerenone) | β οΈ Avoid if KβΊ >5.0 or eGFR <30 | β οΈ Caution β hepatic metabolism | β Safe | β οΈ Avoid in pregnancy | β Proven mortality benefit | β Reduces proteinuria | Monitor KβΊ & renal function |
| Direct Renin Inhibitor (Aliskiren) | β Avoid β renally cleared | β οΈ Avoid | β Safe | β Contraindicated | β οΈ Limited data | β οΈ Not first-line | Do not combine with ACEi/ARB |
| Vasodilating Beta-blockers (Labetalol, Carvedilol, Nebivolol) | β Preferred in CKD / DM | β οΈ Dose adjust in CLD | β οΈ Avoid non-selective if asthma | β Labetalol = first-line in pregnancy | β Carvedilol for HFrEF | β Good metabolic profile | Labetalol safe for gestational HTN & pre-eclampsia |
Remember this hypertension treatment new guidelines to treat patients in better way.
