Patient Factors Affecting Antihypertensive Drug Choice
The choice between the drugs is to a large degree determined by the characteristics of the patient being prescribed for, the drugs' side-effects, and cost. Most drugs have other uses; sometimes the presence of other symptoms can warrant the use of one particular antihypertensive. Examples include:
- Age can affect choice of medications. Current UK guidelines suggest starting patients over the age of 55 years first on calcium channel blockers or thiazide diuretics.
- Anxiety may be improved with the use of beta blockers.
- Asthmatics have been reported to have worsening symptoms when using beta blockers.
- Benign prostatic hyperplasia may be improved with the use of an alpha blocker.
- Diabetes. The ace inhibitors and angiotensin receptor blockers have been shown to prevent the renal and retinal complications of diabetes mellitus.
- Gout may be worsened by diuretics, while losartan reduces serum urate.
- Kidney stones may be improved with the use of thiazide-type diuretics
- Heart block β-blockers and nondihydropyridine calcium channel blockers should not be used in patients with heart block greater than first degree.
- Heart failure may be worsened with nondihydropyridine calcium channel blockers, the alpha blocker doxazosin, and the alpha-2 agonists moxonidine and clonidine. Whereas β-blockers, diuretics, ACE inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists have been shown to improve outcome.
- Pregnancy. Although α-methyldopa is generally regarded as a first-line agent, labetalol and metoprolol are also acceptable. Atenolol has been associated with intrauterine growth retardation, as well as decreased placental growth and weight when prescribed during pregnancy. Ace inhibitors and angiotensin II receptor blockers (ARBs)are contraindicated in women who are or who intend to become pregnant.
- Race. The JNC 7 particularly points out that when used as monotherapy, thiazide diuretics and calcium channel blockers have been found to be more effective for reducing blood pressure in African-American patients than β-blockers, ACE inhibitors, or ARBs.
- Tremor may warrant the use of beta blockers.
The JNC 7 report outlines compelling reasons to choose one drug over the others for certain individual patients.
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