957

TABLE 44-5 Oral Antihypertensive Drugs

DOSE RANGE, TOTAL MG/DAY DOSE RANGE, TOTAL MG/DAY 44
DRUG (DOSES PER DAY) DRUG (DOSES PER DAY)

Systemic Hypertension: Management

Diuretics Angiotensin-Converting Enzyme Inhibitors
Thiazide and Thiazide-Type Diuretics Benazepril 10-80 (1-2)
Chlorthalidone 6.25-50 (1) Captopril 25-150 (2)
HCTZ 6.25-50 (1) Enalapril 2.5-40 (2)
Indapamide 1.25-5 (1) Fosinopril 10-80 (1-2)
Metolazone 2.5-5 (1) Lisinopril 5-80 (1-2)
Loop Diuretics Moexipril 7.5-30 (1)
Furosemide 20-160 (2) Perindopril 4-16 (1)
Torsemide 2.5-0 (1-2) Quinapril 5-80 (1-2)
Bumetanide 0.5-2 (2) Ramipril 2.5-20 (1)
Ethacrynic acid 25-100 (2) Trandolapril 1-8 (1)
Potassium-Sparing Diuretics Angiotensin Receptor Blockers
Amiloride 5-20 (1) Candesartan 8-32 (1)
Triamterene 25-100 (1) Eprosartan 400-800 (1-2)
Spironolactone 12.5-400 (1-2) Irbesartan 150-300 (1)
Eplerenone 25-100 (1-2) Losartan 25-100 (2)
Beta Blockers Olmesartan 5-40 (1)
Standard Beta Blockers Telmisartan 20-80 (1)
Acebutolol 200-800 (2) Valsartan 80-320 (1-2)
Atenolol 25-100 (1) Direct Renin Inhibitor
Betaxolol 5-20 (1) Aliskiren 75-300 (1)
Bisoprolol 2.5-20 (1) Alpha Blockers
Carteolol 2.5-10 (1) Doxazosin 1-16 (1)
Metoprolol 50-450 (2) Prazosin 1-40 (2-3)
Metoprolol XL 50-200 (1-2) Terazosin 1-20 (1)
Nadolol 20-320 (1) Phenoxybenzamine 20-120 (2) for
pheochromocytoma
Penbutolol 10-80 (1)
Central Sympatholytics
Pindolol 10-60 (2)
Clonidine 0.2-1.2 (2-3)
Propranolol 40-180 (2)
Clonidine patch 0.1-0.6 (weekly)
Propranolol LA 60-180 (1-2)
Guanabenz 2-32 (2)
Timolol 20-60 (2)
Guanfacine 1-3 (1) (qhs)
Vasodilating Beta Blockers
Methyldopa 250-1000 (2)
Carvedilol 6.25-50 (2)
Reserpine 0.05-0.25 (1)
Carvedilol CR 10-40 (1)
Direct Vasodilators
Nebivolol 5-40 (1)
Hydralazine 10-200 (2)
Labetalol 200-2400 (2)
Minoxidil 2.5-100 (1)
Calcium Channel Blockers
Fixed-Dose Combinations
Dihydropyridines
Aliskiren/HCTZ 75-300/12.5-25 (1)
Amlodipine 2.5-10 (1)
Amiloride/HCTZ 5/50 (1)
Felodipine 2.5-20 (1-2)
Amlodipine/benazepril 2.5-5/10-20 (1)
Isradipine CR 2.5-20 (2)
Amlodipine/valsartan 5-10/160-320 (1)
Nicardipine SR 30-120 (2)
Amlodipine/olmesartan 5-10/20-40 (1)
Nifedipine XL 30-120 (1)
Atenolol/chlorthalidone 50-100/25 (1)
Nisoldipine 10-40 (1-2)
Benazepril/HCTZ 5-20/6.25-25 (1)
Nondihydropyridines
Bisoprolol/HCTZ 2.5-10/6.25 (1)
Diltiazem CD 120-540 (1)
Candesartan/HCTZ 16-32/12.5-25 (1)
Verapamil HS 120-480 (1)

Continued
 958
TABLE 44-5 Oral Antihypertensive Drugs—cont’d
VI DOSE RANGE, TOTAL MG/DAY DOSE RANGE, TOTAL MG/DAY
DRUG (DOSES PER DAY) DRUG (DOSES PER DAY)
PREVENTIVE CARDIOLOGY

Enalapril/HCTZ 5-10/25 (1-2) Olmesartan/amlodipine/HCTZ 20-40/5-10/12.5-25 (1)

Eprosartan/HCTZ 600/12.5-25 (1) Spironolactone/HCTZ 25/25 (1/2-1)
Fosinopril/HCTZ 10-20/12.5 (1) Telmisartan/HCTZ 40-80/12.5-25 (1)
Irbesartan/HCTZ 15-30/12.5-25 (1) Trandolapril/verapamil 2-4/180-240 (1)
Losartan/HCTZ 50-100/12.5-25 (1) Triamterene/HCTZ 37.5/25 ( 12-1)
Olmesartan/amlodipine 20-40/5-10 (1) Valsartan/HCTZ 80-160/12.5-25 (1)
Olmesartan/HCTZ 20-40/12.5-25 (1) Valsartan/amlodipine/HCTZ 80-160/5-10/12.5-25 (1)

TABLE 44-6 Contraindications to the Use of Specific Antihypertensive Drugs

DRUG COMPELLING POSSIBLE
Diuretics (thiazide) Gout Metabolic syndrome
Glucose intolerance
Pregnancy
Hypercalcemia
Hypokalemia
Beta blockers Asthma Metabolic syndrome
Atrioventricular block (grade 2 or 3) Glucose intolerance (except for vasodilating beta blockers)
Athletes and physically active patients
Chronic obstructive pulmonary disease
Dihydropyridine calcium Tachyarrhythmia
channel blockers Heart failure
Nondihydropyridine Atrioventricular block (grade 2 or 3, trifascicular block)
calcium channel blockers Severe left ventricular heart dysfunction
Heart failure
Angiotensin-converting Pregnancy Women with childbearing potential
enzyme inhibitors Angioedema
Hyperkalemia
Bilateral renal artery stenosis
Angiotensin receptor Pregnancy Women with childbearing potential
blockers Hyperkalemia
Bilateral renal artery stenosis
Aldorsterone antagonists Acute or severe renal failure (estimated glomerular
filtration rate < 30 mL/min)
Hyperkalemia

TABLE 44-7 Preferred Antihypertensive Drugs for Specific Conditions

CONDITION DRUG OR DRUGS
Patients with prehypertension ARB?
Hypertensive patients in general CCB, ACEI or ARB, D
Hypertension in older patients CCB, ACEI or ARB, D
Hypertension with LVH ARB, D, CCB
Hypertension in patients with diabetes mellitus CCB, ACEI or ARB, D
Hypertension in patients with diabetic neuropathy ARB, D
Hypertension in patients with nondiabetic chronic kidney disease ACEI, BB, D
BP reduction for secondary prevention of coronary events ACEI, CCB, BB, D
BP reduction for secondary prevention of stroke ACEI + D, CCB
BP for patients with heart failure D, BB, ACEI, ARB, aldosterone antagonists
Pregnancy Methyldopa, BB, CCB
Aortic aneurysm BB
Atrial fibrillation, ventricular rate control BB, nondihydropyridine CCB

BB = beta blocker; D = diuretic; LVH = left ventricular hypertrophy.

Modified from Mancia G, Fagard R, Narkiewicz K, et al: 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of
Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 31:1281, 2013.