Antihypertensives

Antihypertensive types

• Diuretics
• Calcium channel blockers
• ACE inhibitors
• Angiotensin II receptor antagonists (ARBs)
• Adrenergic receptor antagonists
  • Beta blockers
  • Alpha-1 blockers
• Alpha-2 agonists

Initial outpatient hypertension medications

• First line for people without comorbidities
  • Hydrochlorothiazide 12.5mg, max 25mg
    • Need labs before starting, does not work in people with CKD
• First line for people with DM and/or proteinuria
  • ACEi/ARB: Lisinopril either Qday or BID
    • Need Chem 10 before and after starting to check for hyperkalemia and creatinine
    • Start 10mg lisinopril QD
• Anyone with CAD, CHF
  • Beta-Blocker (do not need labs)
• Amlodipine for anyone, except for people with LE edema (do not need labs)
  • Start amlodipine 5mg QD
• Diltiazem for proteinuria in people unable to tolerate ACEi (do not need labs)
• Lasix for CHF and/or lower extremity edema secondary to proteinuria

JNC 8 Recommendations

Population	Non-black Patients	Black Patients
General population	thiazide, CCB, ACEI, or ARB	thiazide or CCB
CKD	ACEI or ARB	ACEI or ARB
DM	thiazide, CCB, ACEI, or ARB	thiazide or CCB

See Also

• Hypertension (main)

James PA, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-520.